Establishing Beneficiary Equity in the Hospital Readmission Program Act

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. Short title This Act may be cited as the Establishing Beneficiary Equity in the Hospital Readmission Program Act 2. Adjusting the Medicare hospital readmission reduction program to respond to patient disparities (a) Removal of certain readmissions Section 1886(q)(5)(E) of the Social Security Act ( 42 U.S.C. 1395ww(q)(5)(E) Such term does not include an admission that is classified within one or more of the following: transplants, end-stage renal disease, burns, trauma, psychosis, or substance abuse. (b) Adjustment for dual eligible population Section 1886(q)(4)(C) of the Social Security Act ( 42 U.S.C. 1395ww(q)(4)(C) (iii) Adjustment for dual eligibles In applying clause (i), the Secretary shall provide for such risk adjustment as will take into account a hospital’s proportion of inpatients who are full-benefit dual eligible individuals (as defined in section 1935(c)(6)) in order to ensure that hospitals that treat the most vulnerable populations are not unfairly penalized by the program under this subsection. . (c) MedPAC study on 30-Day readmission threshold The Medicare Payment Advisory Commission shall conduct a study on the appropriateness of using a threshold of 30 days for readmissions under section 1886(q)(5)(E) of the Social Security Act ( 42 U.S.C. 1395ww(q)(5)(E) (d) Addressing issue of noncompliant patients Section 1886(q)(4)(C) of the Social Security Act ( 42 U.S.C. 1395ww(q)(4)(C) (iv) Consideration of exclusion of noncompliant patient cases based on V codes In promulgating regulations to carry out this subsection for the applicable period with respect to fiscal year 2015, the Secretary shall consider the use of V codes for potential exclusions of cases in order to address the issue of noncompliant patients. . (e) Effective date; budget neutral implementation (1) The amendments made by this section shall be effective for applicable periods with respect to fiscal year 2015 and each succeeding fiscal year. (2) The Secretary of Health and Human Services shall make such payment adjustment to subsection (d) hospitals under the inpatient prospective payment system under section 1886 of the Social Security Act ( 42 U.S.C. 1395ww

Summary: Establishing Beneficiary Equity in the Hospital Readmission Program Act - Amends title XVIII (Medicare) of the Social Security Act (SSA) with respect to the hospital readmission reduction program to exclude from the program admissions related to transplants, end-stage renal disease (ESRD), burns, trauma, psychosis, or substance abuse. Requires the Secretary of Health and Human Services (HHS), in applying requirements for the excess readmission ratio, to provide for a risk adjustment that will take into account a hospital's proportion of inpatients who are full-benefit dual eligible individuals (eligible for both Medicare and Medicaid under SSA title XIX) in order to ensure that hospitals that treat the most vulnerable populations are not unfairly penalized. Directs the Medicare Payment Advisory Commission (MEDPAC) to study the appropriateness of using a threshold of 30 days for readmissions under the program. Directs the Secretary, in promulgating regulations for the hospital readmission reduction program, to consider the use of V codes for potential exclusions of cases involving noncompliant patients in promulgating applicable regulations.