I 

113TH CONGRESS 

2D SESSION H. R. 4188 

To amend title XVIII of the Social Security Act to adjust the Medicare 

hospital readmission reduction program to respond to patient disparities, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 11, 2014 

Mr. RENACCI (for himself, Mr. HECK of Nevada, Mr. JOYCE, Mr. RYAN of 

Ohio, Mr. FITZPATRICK, Mr. TURNER, Mr. KELLY of Pennsylvania, Mrs. 

CAPITO, Mr. STIVERS, Mr. TIBERI, Mr. LAMALFA, Mr. PERRY, Mr. SAM

JOHNSON of Texas, Mr. GIBBS, Mr. CHABOT, Mr. MEEHAN, Mr. JOHNSON of Ohio, Mr. CARNEY, Mr. JOHNSON of Georgia, Mr. ENGEL, Ms. 

KAPTUR, Mr. DAVID SCOTT of Georgia, and Ms. EDDIE BERNICE JOHNSON of Texas) introduced the following bill; which was referred to the 

Committee on Ways and Means 

A BILL 

To amend title XVIII of the Social Security Act to adjust 

the Medicare hospital readmission reduction program to 

respond to patient disparities, 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 ‘‘Establishing Bene5 ficiary Equity in the Hospital Readmission Program Act’’. 


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1 SEC. 2. ADJUSTING THE MEDICARE HOSPITAL READMIS2 SION REDUCTION PROGRAM TO RESPOND TO 

3 PATIENT DISPARITIES. 

4 (a) REMOVAL OF CERTAIN READMISSIONS.—Section 

5 1886(q)(5)(E) of the Social Security Act (42 U.S.C. 

6 1395ww(q)(5)(E)) is amended by adding at the end the 

7 following: ‘‘Such term does not include an admission that 

8 is classified within one or more of the following: trans9 plants, end-stage renal disease, burns, trauma, psychosis, 

10 or substance abuse.’’. 

11 (b) ADJUSTMENT FOR DUAL ELIGIBLE POPU12 LATION.—Section 1886(q)(4)(C) of the Social Security 

13 Act (42 U.S.C. 1395ww(q)(4)(C)) is amended by adding 

14 at the end the following new clause: 

15 ‘‘(iii) ADJUSTMENT FOR DUAL ELIGI16 BLES.—In applying clause (i), the Sec17 retary shall provide for such risk adjust18 ment as will take into account a hospital’s 

19 proportion of inpatients who are full-ben20 efit dual eligible individuals (as defined in 

21 section 1935(c)(6)) in order to ensure that 

22 hospitals that treat the most vulnerable 

23 populations are not unfairly penalized by 

24 the program under this subsection.’’. 

25 (c) MEDPAC STUDY ON 30-DAY READMISSION

26 THRESHOLD.—The Medicare Payment Advisory CommisVerDate Mar 15 2010 02:13 Mar 13, 2014 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4188.IH H4188

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1 sion shall conduct a study on the appropriateness of using 

2 a threshold of 30 days for readmissions under section 

3 1886(q)(5)(E) of the Social Security Act (42 U.S.C. 

4 1395ww(q)(5)(E)). The Commission shall submit to Con5 gress a report on such study in its report to Congress in 

6 June 2014. 

7 (d) ADDRESSING ISSUE OF NONCOMPLIANT PA8 TIENTS.—Section 1886(q)(4)(C) of the Social Security 

9 Act (42 U.S.C. 1395ww(q)(4)(C)), as amended by sub10 section (b), is further amended by adding at the end the 

11 following new clause: 

12 ‘‘(iv) CONSIDERATION OF EXCLUSION

13 OF NONCOMPLIANT PATIENT CASES BASED

14 ON V CODES.—In promulgating regulations 

15 to carry out this subsection for the applica16 ble period with respect to fiscal year 2015, 

17 the Secretary shall consider the use of V 

18 codes for potential exclusions of cases in 

19 order to address the issue of noncompliant 

20 patients.’’. 

21 (e) EFFECTIVE DATE; BUDGET NEUTRAL IMPLE22 MENTATION.— 

23 (1) The amendments made by this section shall 

24 be effective for applicable periods with respect to fis25 cal year 2015 and each succeeding fiscal year. 


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1 (2) The Secretary of Health and Human Serv2 ices shall make such payment adjustment to sub3 section (d) hospitals under the inpatient prospective 

4 payment system under section 1886 of the Social 

5 Security Act (42 U.S.C. 1395ww) as may be nec6 essary to ensure that the implementation of the 

7 amendments made by this section do not result in an 

8 increase in aggregate expenditures under such sec9 tion. 

Æ 


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