H.R. 5273, Helping Hospitals Improve Patient Care Act of 2016

H.R. 5273

Helping Hospitals Improve Patient Care Act of 2016

Sponsor
Rep. Pat Tiberi

Committee
Ways and Means

Date
June 7, 2016 (114th Congress, 2nd Session)

Staff Contact
John Huston

Floor Situation

On Tuesday, June 7, 2016, the House will consider H.R. 5273, the Helping Hospitals Improve Patient Care Act of 2016. H.R. 5273 was introduced on May 18, 2016 by Rep. Patrick Tiberi (R-OH), and was referred to the Committee on Ways and Means, which ordered the bill reported by voice vote on May 24, 2016.

Bill Summary

H.R. 5273 would amend the Bipartisan Budget Act of 2015 (BBA) to improve payment disbursements to hospitals and other Medicare providers, by resolving two issues that were created with the enactment of the BBA, in addition to other provisions.[1]

Relief to Hospital Outpatient Departments “Mid-Build”—This provision reverses the site-neutral pay cuts for hospital outpatient departments (HOPDs) that were “mid-build” when BBA passed last year, as the law did not take into account these types of facilities. Mid-build is defined as “a provider that, before November 2, 2015, had a binding written agreement with an outside unrelated party for the actual construction of the department.” This will allow providers that were already building new off-campus outpatient facilities to be grandfathered into the outpatient payment rates.

Relief to Hospital Outpatient Departments in Dedicated Cancer Centers—This provision provides an exemption from the HOPD policy created in the BBA to continue to allow cancer hospitals to be paid at cancer hospital rates at new off-campus locations.[2]

Refinements of the Medicare Hospital Readmissions Program—This provision provides a bridge to consideration of socioeconomic status in the Hospital Readmissions Reduction Program. Until reports and data required under the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT) are available, the Secretary of Health and Human Services (HHS) would compare performance of hospitals that service similar proportions of dual-eligible individuals in applying adjustments under the Readmissions program. After the IMPACT studies are completed, the Secretary would be able to adjust the performance based on the IMPACT data and research.

Other Provisions — The bill also includes other provisions included within the following House bills:

H.R. 2582, the Seniors’ Health Care Plan Protection Act of 2015 (passed the House by voice vote on June 17, 2015)—the bill delays the ability of the Centers for Medicare and Medicaid Services (CMS) to terminate MA plans solely on the basis of low quality ratings until the end of plan year 2018 to resolve socioeconomic status issues. The Centers for Medicare and Medicaid Services (CMS) uses a five-star rating system to assess the quality and performance of Medicare Advantage (MA) plans. There are concerns that an MA plan’s performance under this five-star rating system may be impacted by factors other than the actions of the plans and providers themselves; for example, by socioeconomic factors beyond their control, such as poverty. Failing to account for these factors may lead some plans to score more poorly on performance measures simply because of the composition of those enrolled in their plans, not on an actual inadequacy in their performance.[3]

H.R. 2505, the Medicare Advantage Coverage Transparency Act of 2015 (passed the House on by voice vote on June 17, 2015)—The bill requires HHS to report Medicare enrollment information by zip code, congressional district.[4]

H.R. 3291, the Medicare Crosswalk Hospital Code Development Act of 2015—The bill requires HHSS to develop a cross walk of ten inpatient surgical codes that will be linked to outpatient surgical codes

H.R. 887, the Electronic Health Fairness Act of 2015 (Ordered reported by the Ways and Means Committee by voice vote on February 26, 2015)—The provision excludes ambulatory surgical center (ASC) services from being counted toward the 50 percent meaningful use eligibility threshold until certified electronic health record (EHR) systems applicable to the ASC setting are available.  The exclusion will expire three years after the Secretary of the Department of Health and Human Services has certified such EHR systems. According to the Committee, this provision resolves a burden faced by physicians practicing in ASC settings without slowing the adopting of EHR technology.[5]

H.R. 1343, the Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015—The bill provides “mid-build” exception to the current law on increasing the number of beds for long-term care hospitals (LTCHs).

H.R. 2580, the LTCH Technical Correction Act of 2015 (Ordered reported by the Ways and Means Committee by voice vote on June 2, 2015)— The bill provides “mid-build” exception to the current law on increasing the number of beds for long-term care hospitals (LTCHs).[6]

H.R. 2506, the Seniors’ Health Care Plan Protection Act of 2015 (Ordered reported by the Ways and Means Committee by voice vote on June 2, 2015)— The bill delays the termination of Medicare Advantage contracts for plans that receive three stars or fewer under the performance standards of the STARS ratings system for three consecutive years. According to the Committee, the STARS ratings system does not properly account for beneficiary socioeconomic status and the amount of low-income and dual beneficiaries enrolled by a plan.[7]

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[1] See Committee on Ways and Means, “The Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273),” May 18, 2016.
[2] Id.
[3] See Legislative Digest H.R. 2582
[4] See Legislative Digest H.R. 2505
[5] See House Report 114-40
[6] See House Report 114-156
[7] See House Report 114-158

Background

H.R.5273 attempts to rectify several issues hospitals had with various Medicare payment issues which stem from the enactment of the Bipartisan Budget Act. For instance, the hospital industry has claimed the provisions about site neutral payment policies and cancer hospitals are needed to overcome issues that stemmed from the enactment of the Bipartisan Budget Act of 2015 which did not provide for hospital outpatient departments that had already begun construction to build facilities based on the prior reimbursement amounts. Separately, hospitals that serve many low-income patients have long called for a special payment adjustment under Medicare’s readmissions reduction program, because they tend to have higher readmission rates compared with facilities that have a higher proportion of wealthier beneficiaries. H.R. 5273 aims at providing such regulatory relief.

According to the bill’s sponsor, “The Helping Hospitals Improve Patient Care Act takes responsible steps to strengthen Medicare and give hospitals and health care providers the certainty they need to best serve their patients.”[1]

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[1] See Rep. Patrick Tiberi, Press Release, “Tiberi, McDermott Introduce Bill to Help Hospitals and Improve Patient Care,” May 18, 2016.

 

Cost

A Congressional Budget Office estimate is not available at this time, however, according to the Committee, this legislation is fully offset.[1]

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[1] See Committee on Ways and Means, “The Helping Hospitals Improve Patient Care Act of 2016 (H.R. 5273),” May 18, 2016.

Additional Information

For questions or further information please contact John Huston with the House Republican Policy Committee by email or at 6-5539