I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Partial Hospitalization 

5 Stabilization and Integrity Act of 2011’’. 


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1 SEC. 2. MEDICARE PAYMENT FOR PARTIAL HOSPITALIZA2 TION SERVICES. 

3 (a) ESTABLISHMENT OF NEW PAYMENT METHOD4 OLOGY.—Section 1833 of the Social Security Act (42 

5 U.S.C. 1395l) is amended— 

6 (1) in subsection (a)(2)— 

7 (A) in subparagraph (B), by striking ‘‘or 

8 (E)’’ and inserting ‘‘(E), or (I)’’; 

9 (B) in subparagraph (G), by striking 

10 ‘‘and’’ at the end; 

11 (C) in subparagraph (H), by striking the 

12 comma at the end and inserting ‘‘; and’’; and 

13 (D) by inserting after subparagraph (H) 

14 the following new subparagraph: 

15 ‘‘(I) with respect to partial hospitalization 

16 services, the amount determined under sub17 section (z);’’; 

18 (2) in subsection (t)(2)(B)— 

19 (A) in clause (iii), by striking ‘‘but’’; 

20 (B) in clause (iv), by striking the period at 

21 the end and inserting ‘‘; and’’; and 

22 (C) by adding at the end the following new 

23 clause: 

24 ‘‘(v) does not include partial hos25 pitalization services.’’; and 


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1 (3) by adding at the end the following new sub2 section: 

3 ‘‘(z) PAYMENT FOR PARTIAL HOSPITALIZATION

4 SERVICES.— 

5 ‘‘(1) IN GENERAL.—The Secretary shall estab6 lish consistent with this subsection a payment sys7 tem for partial hospitalization services. Such pay8 ment system shall be designed to provide for the 

9 same payment rates without regard to whether the 

10 services are furnished by a hospital or by a commu11 nity mental health center, to minimize annual fluc12 tuations in overall rates, and to result in an aggre13 gate amount of payment under this part for such 

14 services during the first 5 years in which this sub15 section is effective equal to the aggregate amount of 

16 payment that would have been made under this part 

17 for such services during such period if the Partial 

18 Hospitalization Stabilization and Integrity Act of 

19 2011 had not been enacted. 

20 ‘‘(2) DESCRIPTION OF SYSTEM.—Under such 

21 payment system— 

22 ‘‘(A) payments shall be made based on a 

23 per diem rate (computed consistent with sub24 paragraph (B)) and subject to an annual inVerDate Mar 15 2010 00:07 Nov 18, 2011 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3442.IH H3442

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1 crease (consistent with subparagraphs (C) and 

2 (D) and paragraph (1)); 

3 ‘‘(B) the base per diem rate for services 

4 furnished in 2011 under this subparagraph 

5 shall be deemed to be $238.33 for partial hos6 pitalization services (including mental health 

7 services composite), $82.73 with respect to brief 

8 individual psychotherapy, $113.05 for extended 

9 individual psychotherapy, $128.82 for extended 

10 individual psychotherapy, and $54.87 for group 

11 psychotherapy; 

12 ‘‘(C) the annual adjustment under this 

13 subparagraph shall be, subject to subparagraph 

14 (D) and paragraph (1), a uniform inflation fac15 tor, such as the consumer price index for all 

16 urban consumers, to be specified by the Sec17 retary; 

18 ‘‘(D) such annual adjustment— 

19 ‘‘(i) if an increase, shall be— 

20 ‘‘(I) provided in full only for 

21 those providers of partial hospitaliza22 tion services that meet performance 

23 standards specified by the Secretary 

24 consistent with the quality service criVerDate Mar 15 2010 00:07 Nov 18, 2011 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3442.IH H3442

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1 teria established under paragraph (3) 

2 and paragraph (4); and 

3 ‘‘(II) reduced for those providers 

4 of such services that fail to meet such 

5 performance standards; and 

6 ‘‘(ii) if a decrease, shall be— 

7 ‘‘(I) provided in full for those 

8 providers of such services that fail to 

9 meet such standards; and 

10 ‘‘(II) reduced for those providers 

11 of such services that meet such stand12 ards; and 

13 ‘‘(E) payment shall not be made for partial 

14 hospitalization services with a level of care of 

15 fewer than 4 services per service day. 

16 ‘‘(3) ESTABLISHMENT OF QUALITY SERVICE

17 CRITERIA TO JUDGE PERFORMANCE.—In order to 

18 carry out paragraph (2)(D), the Secretary shall es19 tablish criteria to measure performance of providers 

20 of partial hospitalization services. Such criteria shall 

21 include criteria relating to at least the following: 

22 ‘‘(A) ACCESS.—The number of program 

23 days of scheduled operation from the time of a 

24 request for services to the first scheduled day of 

25 service. 


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1 ‘‘(B) TREATMENT INTENSITY.—The per2 centage of scheduled attendance consistent with 

3 a minimum attendance average of 4 days per 

4 calendar week over an episode of care. 

5 ‘‘(C) DISCHARGE PLANNING.—The per6 centage of patients with a scheduled follow-up 

7 appointment within 14 days after the date of 

8 discharge (as needed). 

9 ‘‘(D) CONTINUITY OF CARE.—The percent10 age of post-discharge continuity of care plans 

11 provided to next level of care providers upon 

12 discharge. 

13 ‘‘(4) REQUIREMENT FOR ACCREDITATION.—Ef14 fective 2 years after the date of the enactment of 

15 this subsection, a provider of partial hospitalization 

16 services shall not be considered to meet performance 

17 standards under paragraph (2)(D) unless the pro18 vider is accredited by the Joint Commission on Ac19 creditation of Healthcare Organizations, the Com20 mission on Accreditation of Rehabilitation Facilities, 

21 or such other accreditation body as may be recog22 nized by the Secretary.’’. 

23 (b) CONFORMING COVERAGE OF MENTAL HEALTH

24 SERVICES COMPOSITE FURNISHED BY COMMUNITY MEN25 TAL HEALTH CENTERS.—Under section 1861(ff)(2)(I) of 


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1 the Social Security Act (42 U.S.C. 1395x(ff)(2)(I)), the 

2 Secretary of Health and Human Services shall include 

3 such items and services as would result in the same scope 

4 of items and services covered under partial hospitalization 

5 services if furnished by a community mental health center 

6 as would be covered as partial hospitalization services if 

7 furnished by a hospital. 

8 (c) EFFECTIVE DATE.—This section, and the amend9 ments made by this section, shall apply to services fur10 nished on or after January 1, 2012. 

Æ 


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