II 

110TH CONGRESS 

2D SESSION S. 3116 

To amend title XVIII of the Social Security Act to stabilize and modernize 

the provision of partial hospitalization services under the Medicare program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 11, 2008 

Mr. VITTER introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to stabilize 

and modernize the provision of partial hospitalization 

services under the Medicare program, and for other purposes. 

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 ‘‘Outpatient Mental 

5 Health Modernization Act of 2008’’. 


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1 SEC. 2. TRANSITIONAL FREEZE ON CERTAIN MEDICARE 

2 HOSPITAL OUTPATIENT FEE SCHEDULE 

3 AMOUNTS. 

4 Notwithstanding any other provision of law, effective 

5 for episodes and visits beginning on or after January 1, 

6 2009, and before January 1, 2010, in the case of partial 

7 hospital services (as defined in section 1861(ff)(1) of the 

8 Social Security Act (42 U.S.C. 1395x(ff)(1)), the OPD fee 

9 schedule increase factor under section 1833(t)(3)(C)(iv) of 

10 the Social Security Act (42 U.S.C. 1395l(t)(3)(C)(iv)) for 

11 the medicare OPD fee schedule amount established for 

12 such services (as published in the Federal Register on No13 vember 27, 2007 (72 Fed. Reg. 66670)) shall be zero. 

14 SEC. 3. ACCREDITATION PROGRAM FOR COMMUNITY MEN15 TAL HEALTH CENTERS PROVIDING PARTIAL 

16 HOSPITALIZATION SERVICES. 

17 Section 1833(t) of the Social Security Act (42 U.S.C. 

18 1395l(t)) is amended by adding at the end the following 

19 new paragraph: 

20 ‘‘(18) ACCREDITATION PROGRAM FOR COMMU21 NITY MENTAL HEALTH CENTERS PROVIDING PAR22 TIAL HOSPITALIZATION SERVICES.— 

23 ‘‘(A) DEFINITIONS.—In this section: 

24 ‘‘(i) ACCREDITATION ORGANIZA25 TION.—The term ‘accreditation organiza26 tion’ means an organization designated by 


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1 the Secretary under subparagraph 

2 (C)(i)(II) to accredit community mental 

3 health centers providing partial hospitaliza4 tion services. 

5 ‘‘(ii) PARTIAL HOSPITALIZATION

6 SERVICES.—The term ‘partial hospitaliza7 tion services’ has the meaning given such 

8 term in section 1861(ff)(1). 

9 ‘‘(iii) PHYSICIAN.—Except as other10 wise provided by the Secretary, the term 

11 ‘physician’ means any individual who fur12 nishes services for which payment may be 

13 made under the physician fee schedule 

14 under section 1848. 

15 ‘‘(iv) PHYSICIAN SPECIALTY ORGANI16 ZATION.—The term ‘physician specialty or17 ganization’ means a United States medical 

18 specialty society that represents diplomats 

19 certified by a board recognized by the 

20 American Board of Medical Specialties. 

21 ‘‘(B) ESTABLISHMENT.—Not later than 

22 January 1, 2010, subject to the succeeding pro23 visions of this paragraph, the Secretary shall, 

24 by regulation, establish an accreditation pro25 gram which requires the accreditation of comVerDate Aug 31 2005 03:41 Jun 12, 2008 Jkt 069200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3116.IS S3116

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1 munity mental health centers providing partial 

2 hospitalization services. 

3 ‘‘(C) DESIGN OF ACCREDITATION PRO4 GRAM.— 

5 ‘‘(i) IN GENERAL.—Each community 

6 mental health center providing partial hos7 pitalization services for which payment is 

8 made under the prospective payment sys9 tem established under this subsection must 

10 be accredited for each program under 

11 which such services are furnished by the 

12 community mental health center by an ac13 crediting organization designated by the 

14 Secretary under clause (ii). 

15 ‘‘(ii) ACCREDITATION ORGANIZA16 TIONS.— 

17 ‘‘(I) IN GENERAL.—The Sec18 retary shall, by regulation, designate 

19 entities to accredit community mental 

20 health centers providing partial hos21 pitalization services. The entities des22 ignated under the preceding sentence 

23 shall include the Joint Commission on 

24 Accreditation of Hospitals and the 


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1 Commission on Accreditation of Reha2 bilitation Facilities. 

3 ‘‘(II) CONSULTATION.—In desig4 nating entities under subclause (I), 

5 the Secretary shall consult with aca6 demic medical centers, community 

7 mental health centers, hospitals, and 

8 other appropriate medical personnel 

9 (such as psychologists, social workers, 

10 and nurse specialists). 

11 ‘‘(iii) CONSIDERATIONS.—In desig12 nating entities under clause (ii), the Sec13 retary shall consider the following: 

14 ‘‘(I) The ability of the entity to 

15 conduct timely reviews of accredita16 tion applications. 

17 ‘‘(II) Whether the entity has es18 tablished a process for the timely inte19 gration of new services and clinical 

20 interventions for individuals who are 

21 furnished partial hospitalization serv22 ices. 

23 ‘‘(III) Any other factors the Sec24 retary determines appropriate. 


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1 ‘‘(iv) USE OF CRITERIA FOR ACCREDI2 TATION.—Accreditation organizations shall 

3 use appropriate criteria for evaluating 

4 community mental health centers providing 

5 partial hospitalization services for purposes 

6 of the accreditation of such community 

7 mental health centers, including criteria 

8 with respect to— 

9 ‘‘(I) the qualifications of non10 physician medical personnel; 

11 ‘‘(II) the qualifications and re12 sponsibilities of physicians, including 

13 supervising physicians; 

14 ‘‘(III) the establishment of proce15 dures for ensuring patient safety; and 

16 ‘‘(IV) quality assurance report17 ing. 

18 ‘‘(v) INCORPORATION OF QUALITY

19 MEASURES.—Not later than January 1, 

20 2012, the Secretary shall provide for the 

21 incorporation of measures selected for pur22 poses of quality reporting under paragraph 

23 (19) into the accreditation program estab24 lished under this paragraph, including the 


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1 use of such measures in the criteria for ac2 creditation under clause (iv). 

3 ‘‘(vi) REVIEW OF ACCREDITATION OR4 GANIZATIONS.—The Secretary, in consulta5 tion with the entities and individuals de6 scribed in clause (ii)(II)— 

7 ‘‘(I) shall conduct an annual re8 view of accreditation organizations 

9 designated under clause (ii); and 

10 ‘‘(II) may, by regulation, expand 

11 the original list of accreditation orga12 nizations so designated. 

13 ‘‘(D) EVALUATION AND REPORT.— 

14 ‘‘(i) EVALUATION.—The Secretary 

15 shall contract with an independent, private 

16 organization or entity to evaluate the effect 

17 of the accreditation program established 

18 under this paragraph and other relevant 

19 questions involving access to and value of 

20 partial hospitalization services furnished to 

21 individuals under this part. Such evalua22 tion shall examine the following: 

23 ‘‘(I) The impact of accreditation 

24 requirements on the number, type, 

25 and quality of partial hospitalization 


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1 services furnished to individuals under 

2 this part. 

3 ‘‘(II) The cost of meeting such 

4 accreditation requirements, including 

5 an examination of compliance costs to 

6 community mental health centers pro7 viding partial hospitalization services 

8 and administrative costs to the Sec9 retary. 

10 ‘‘(III) The access of individuals 

11 under this part to partial hospitaliza12 tion services, especially in rural areas, 

13 before and after implementation of 

14 the accreditation program. 

15 ‘‘(IV) Any other matters the Sec16 retary determines appropriate. 

17 ‘‘(ii) REPORT.—Not later than De18 cember 31, 2012, the Secretary shall sub19 mit a report to Congress on the evaluation 

20 conducted under clause (i). 

21 ‘‘(E) WAIVER AUTHORITY.—The Secretary 

22 shall waive compliance with the requirements of 

23 this title to such extent and for such period as 

24 the Secretary determines is necessary to carry 

25 out this paragraph.’’. 


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1 SEC. 4. QUALITY IMPROVEMENT FOR PARTIAL HOS2 PITALIZATION SERVICES PROVIDED BY COM3 MUNITY MENTAL HEALTH CENTERS. 

4 Section 1833(t) of the Social Security Act (42 U.S.C. 

5 1395l(t)), as amended by section 3, is amended by adding 

6 at the end the following new paragraph: 

7 ‘‘(19) QUALITY REPORTING FOR PARTIAL HOS8 PITALIZATION SERVICES PROVIDED BY COMMUNITY

9 MENTAL HEALTH CENTERS.— 

10 ‘‘(A) REDUCTION IN UPDATE FOR FAILURE

11 TO REPORT.—For purposes of paragraph 

12 (3)(C)(iv) for 2009 and each subsequent year, 

13 in the case of a community mental health cen14 ter providing partial hospitalization services (as 

15 defined in section 1861(ff)(1)) that does not 

16 submit, to the Secretary in accordance with this 

17 paragraph, data required to be submitted on 

18 measures selected under this paragraph with re19 spect to such a calendar year, the OPD fee 

20 schedule increase factor under paragraph 

21 (3)(C)(iv) for such year shall be reduced by 1.0 

22 percentage point. A reduction under the pre23 ceding sentence shall apply only with respect to 

24 the year involved and the Secretary shall not 

25 take into account such reduction in computing 


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1 the OPD fee schedule increase factor for a sub2 sequent calendar year. 

3 ‘‘(B) FORM AND MANNER OF SUBMIS4 SION.— 

5 ‘‘(i) IN GENERAL.—Subject to clause 

6 (ii), each community mental health center 

7 providing partial hospitalization services 

8 shall submit to the Secretary data on 

9 measures selected under this paragraph in 

10 a form and manner, and at a time, speci11 fied by the Secretary for purposes of this 

12 paragraph. 

13 ‘‘(ii) GRACE PERIOD FOR SUBMISSION

14 IN 2011.—In the case of such data sub15 mitted with respect to 2011, the Secretary 

16 shall provide for a 30-day grace period for 

17 the submission of such data by a commu18 nity mental health center providing partial 

19 hospitalization services. 

20 ‘‘(C) DEVELOPMENT OF MEASURES.— 

21 ‘‘(i) IN GENERAL.—The Secretary 

22 shall select measures that the Secretary 

23 determines appropriate for the measure24 ment of the quality of care provided by 

25 community mental health centers providing 


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1 partial hospitalization services, including, 

2 beginning with 2011, measures for a set of 

3 5 indicators established by the Secretary. 

4 ‘‘(ii) ADDITIONAL MEASURES.—The 

5 Secretary shall expand, beyond the meas6 ures selected under clause (i) and con7 sistent with the succeeding provisions of 

8 this paragraph, the set of measures that 

9 the Secretary determines appropriate for 

10 the measurement of the quality of care 

11 provided by community mental health cen12 ters providing partial hospitalization serv13 ices. 

14 ‘‘(iii) CONSENSUS MEASURES.—Begin15 ning with 2009, the Secretary shall add 

16 additional measures that reflect consensus 

17 among affected parties and, to the extent 

18 feasible and practicable, shall include 

19 measures set forth by 1 or more national 

20 consensus building entities. 

21 ‘‘(D) REPLACEMENT OF MEASURES.—For 

22 purposes of this paragraph, the Secretary may 

23 replace any measures or indicators in appro24 priate cases, such as where all community men25 tal health centers providing partial hospitalizaVerDate Aug 31 2005 03:41 Jun 12, 2008 Jkt 069200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S3116.IS S3116

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1 tion services are effectively in compliance or the 

2 measures or indicators have been subsequently 

3 shown not to represent the best clinical prac4 tice. 

5 ‘‘(E) AVAILABILITY OF DATA.—The Sec6 retary shall establish procedures for making 

7 data submitted under this paragraph available 

8 to the public. Such procedures shall ensure that 

9 a community mental health center providing 

10 partial hospitalization services has the oppor11 tunity to review the data that are to be made 

12 public with respect to the community mental 

13 health center prior to such data being made 

14 public. The Secretary shall report quality meas15 ures of process, structure, outcome, patients’ 

16 perspectives on care, efficiency, and costs of 

17 care that relate to partial hospitalization serv18 ices on the Internet website of the Centers for 

19 Medicare & Medicaid Services.’’. 

20 SEC. 5. ESTABLISHING MINIMUM NUMBER OF SERVICE 

21 UNITS. 

22 (a) IN GENERAL.—Section 1861(ff)(3)(A) of the So23 cial Security Act (42 U.S.C. 1395x(ff)(3)(A)) is amend24 ed— 


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1 (1) by striking ‘‘, and’’ and inserting a comma; 

2 and 

3 (2) by inserting before the period at the end ‘‘, 

4 and which provides a minimum of 4 units of items 

5 and services described in paragraph (2)’’. 

6 (b) EFFECTIVE DATE.—The amendments made by 

7 this section shall take effect on January 1, 2011. 

8 SEC. 6. COST-REPORTS OF PROVIDERS OF PARTIAL HOS9 PITALIZATION SERVICES. 

10 (a) IN GENERAL.—The Secretary shall require fiscal 

11 intermediaries under the Medicare program under title 

12 XVIII of the Social Security Act to file the cost reports 

13 of providers of partial hospitalization services (as defined 

14 in section 1861(ff)(1) of the Social Security Act (42 

15 U.S.C. 1395x(ff)(1)) into the Healthcare Provider Cost 

16 Reporting Information System (HCRIS) maintained by 

17 the Centers for Medicare & Medicaid Services. 

18 (b) FUNDING.—Out of any funds in the Treasury not 

19 otherwise appropriated, there are appropriated 

20 $1,000,000 to the Secretary of Health and Human Serv21 ices for calendar year 2009 to carry out this section. 

Æ 


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