Sec. 2103. Studies relating to hospital programs paid outside of prospective payment systems
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Using data from hospital programs with respect to which hospitals receive payment outside of the prospective payment systems under sections 1833 and 1886 of the Social Security Act ( 42 U.S.C. 1395l ; 42 U.S.C. 1395ww ) (such programs referred to in this subsection as PPS carve-out programs ) or other data, as available, not later than June 30, 2019, the Medicare Payment Advisory Commission shall submit to Congress a report that evaluates and recommends changes to PPS carve-out programs, including with respect to amendments made by sections 2101 and 2102 of this Act, sections 1814, 1820, 1886(d)(5)(D)(iii), and 1115(A) of the Social Security Act, and such other sections of title XVIII of the Social Security Act deemed appropriate.
To the extent feasible, such report shall make recommendations on a payment methodology under the Medicare program for hospital payments, including with respect to PPS carve-out programs, that differs from the payment methodology applicable to such programs as of September 30, 2017. Not later than 2 years after the date by which the Secretary of Health and Human Services has collected 2 years of data under sections 1886(d)(5)(G) and 1886(d)(12) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(G) ; 42 U.S.C. 1395ww(d)(12) ), as extended pursuant to sections 2101 and 2102 of this Act, the Medicare Payment Advisory Commission shall submit to Congress a report, including— recommendations on payments, including a technical prototype for payments for PPS carve-out programs, if warranted; recommendations, if any, on which Medicare fee-for-service regulations for hospital payments under title XVIII of the Social Security Act should be altered (such as the critical access hospital 96-hour rule); an analysis of the impact of the recommended payments described in paragraph
(1)on Medicare beneficiary cost-sharing, access to care, and choice of setting; a projection of any potential reduction in expenditures under title XVIII of the Social Security Act that may be attributable to the application of the recommended payments described in paragraph (1); a review of the value of hospitals participating in PPS carve-out programs collecting and reporting to the Secretary standardized patient assessment data with respect to inpatient hospital services; the types of rural hospital classifications and payment methodologies under the Medicare program, including information on each special payment structure such as eligibility criteria, and any areas of overlap between such special payment programs; Medicare spending on each PPS carve-out program; the financial aspects of hospitals participating in such PPS carve-out programs, such as the share of discharges under the Medicare and Medicaid programs; and whether such payment programs are empirically justified to support Medicare beneficiary access to care.
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Sec. 2103
Studies relating to hospital programs paid outside of prospective payment systems
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