Partial Hospitalization Stabilization and Intregity Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to establish: (1) a payment system for partial hospitalization services, and (2) quality service criteria to measure the performance of providers of such services.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3442 Introduced in House (IH)]
112th CONGRESS
1st Session
H. R. 3442
To amend title XVIII of the Social Security Act with respect to payment
for partial hospitalization services under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 16, 2011
Ms. Eddie Bernice Johnson of Texas (for herself, Ms. Jackson Lee of
Texas, and Mr. Frank of Massachusetts) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act with respect to payment
for partial hospitalization services under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Partial Hospitalization
Stabilization and Integrity Act of 2011''.
SEC. 2. MEDICARE PAYMENT FOR PARTIAL HOSPITALIZATION SERVICES.
(a) Establishment of New Payment Methodology.--Section 1833 of the
Social Security Act (42 U.S.C. 1395l) is amended--
(1) in subsection (a)(2)--
(A) in subparagraph (B), by striking ``or (E)'' and
inserting ``(E), or (I)'';
(B) in subparagraph (G), by striking ``and'' at the
end;
(C) in subparagraph (H), by striking the comma at
the end and inserting ``; and''; and
(D) by inserting after subparagraph (H) the
following new subparagraph:
``(I) with respect to partial hospitalization
services, the amount determined under subsection
(z);'';
(2) in subsection (t)(2)(B)--
(A) in clause (iii), by striking ``but'';
(B) in clause (iv), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(v) does not include partial
hospitalization services.''; and
(3) by adding at the end the following new subsection:
``(z) Payment for Partial Hospitalization Services.--
``(1) In general.--The Secretary shall establish consistent
with this subsection a payment system for partial
hospitalization services. Such payment system shall be designed
to provide for the same payment rates without regard to whether
the services are furnished by a hospital or by a community
mental health center, to minimize annual fluctuations in
overall rates, and to result in an aggregate amount of payment
under this part for such services during the first 5 years in
which this subsection is effective equal to the aggregate
amount of payment that would have been made under this part for
such services during such period if the Partial Hospitalization
Stabilization and Integrity Act of 2011 had not been enacted.
``(2) Description of system.--Under such payment system--
``(A) payments shall be made based on a per diem
rate (computed consistent with subparagraph (B)) and
subject to an annual increase (consistent with
subparagraphs (C) and (D) and paragraph (1));
``(B) the base per diem rate for services furnished
in 2011 under this subparagraph shall be deemed to be
$238.33 for partial hospitalization services (including
mental health services composite), $82.73 with respect
to brief individual psychotherapy, $113.05 for extended
individual psychotherapy, $128.82 for extended
individual psychotherapy, and $54.87 for group
psychotherapy;
``(C) the annual adjustment under this subparagraph
shall be, subject to subparagraph (D) and paragraph
(1), a uniform inflation factor, such as the consumer
price index for all urban consumers, to be specified by
the Secretary;
``(D) such annual adjustment--
``(i) if an increase, shall be--
``(I) provided in full only for
those providers of partial
hospitalization services that meet
performance standards specified by the
Secretary consistent with the quality
service criteria established under
paragraph (3) and paragraph (4); and
``(II) reduced for those providers
of such services that fail to meet such
performance standards; and
``(ii) if a decrease, shall be--
``(I) provided in full for those
providers of such services that fail to
meet such standards; and
``(II) reduced for those providers
of such services that meet such
standards; and
``(E) payment shall not be made for partial
hospitalization services with a level of care of fewer
than 4 services per service day.
``(3) Establishment of quality service criteria to judge
performance.--In order to carry out paragraph (2)(D), the
Secretary shall establish criteria to measure performance of
providers of partial hospitalization services. Such criteria
shall include criteria relating to at least the following:
``(A) Access.--The number of program days of
scheduled operation from the time of a request for
services to the first scheduled day of service.
``(B) Treatment intensity.--The percentage of
scheduled attendance consistent with a minimum
attendance average of 4 days per calendar week over an
episode of care.
``(C) Discharge planning.--The percentage of
patients with a scheduled follow-up appointment within
14 days after the date of discharge (as needed).
``(D) Continuity of care.--The percentage of post-
discharge continuity of care plans provided to next
level of care providers upon discharge.
``(4) Requirement for accreditation.--Effective 2 years
after the date of the enactment of this subsection, a provider
of partial hospitalization services shall not be considered to
meet performance standards under paragraph (2)(D) unless the
provider is accredited by the Joint Commission on Accreditation
of Healthcare Organizations, the Commission on Accreditation of
Rehabilitation Facilities, or such other accreditation body as
may be recognized by the Secretary.''.
(b) Conforming Coverage of Mental Health Services Composite
Furnished by Community Mental Health Centers.--Under section
1861(ff)(2)(I) of the Social Security Act (42 U.S.C. 1395x(ff)(2)(I)),
the Secretary of Health and Human Services shall include such items and
services as would result in the same scope of items and services
covered under partial hospitalization services if furnished by a
community mental health center as would be covered as partial
hospitalization services if furnished by a hospital.
(c) Effective Date.--This section, and the amendments made by this
section, shall apply to services furnished on or after January 1, 2012.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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