House approves bill to change CMS readmissions program

Accreditation Insider, June 21, 2016

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Last week, the U.S. House of Representatives passed the Helping Hospitals Improve Patient Care Act, which targets several reimbursement issues in the Bipartisan Budget Act of 2015. One of the key provisions of the Act is allowing CMS to determine acceptable readmission rates and penalties by comparing facilities with similar patient populations.

"The Helping Hospitals Improve Patient Care Act takes responsible steps to strengthen Medicare and give hospitals and healthcare providers the certainty they need to best serve their patients," said bill co- sponsor and House Ways and Means Health Subcommittee Chairman Pat Tiberi (R-Ohio), in a statement.

The bill would also do the following:
•    Extend for five years the Rural Community Hospital Demonstration Project
•    Create a "mid-build" exception to the current law on increasing the number of beds for long-term care hospitals
•    Modify the treatment of ambulatory surgery center patient encounters for the meaningful use program
•    Delay in CMS authority to terminate contracts for Medicare Advantage plans failing to achieve minimum quality ratings while CMS conducts research and reports on socioeconomic status and quality ratings
•    Require that CMS report Medicare enrollment data by Congressional district
•    Create a "crosswalk" of 10 inpatient surgical codes that will be linked to outpatient surgical codes

The bill was lobbied for and heavily supported by several hospital organizations, including the American Hospital Association, the Federation of American Hospitals, America's Essential Hospitals, and the Association of American Medical Colleges.

 “America’s hospitals appreciate the leadership of Chairman [Kevin] Brady and Representatives Tiberi and [Jim] McDermott on behalf of the hospital community,” the AHA wrote. “They clearly grasped the unintended consequences of last year’s Bipartisan Budget Act that severely impacted hospital outpatient facilities under development and jeopardized access to patient care. We agree with their policy that the readmissions program needs to be adjusted to account for socioeconomic status.”


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