I 
114TH CONGRESS 
1ST SESSION H. R. 1343 
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 10, 2015 
Mr. RENACCI (for himself, Mr. ENGEL, Mr. KILMER, Mr. DOLD, Mr. AMODEI, 
and Mrs. BROOKS of Indiana) introduced the following bill; which was re-
ferred 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Establishing Bene-
ficiary Equity in the Hospital Readmission Program Act 
of 2015’’. 
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SEC. 2. ESTABLISHING BENEFICIARY EQUITY IN THE MEDI-
CARE HOSPITAL READMISSION PROGRAM. 
(a) TRANSITIONAL ADJUSTMENT FOR DUAL ELIGI-
BLE POPULATION AND SOCIOECONOMIC STATUS.—Sec-
tion 1886(q)(4)(C) of the Social Security Act (42 U.S.C. 
1395ww(q)(4)(C)) is amended by adding at the end the 
following new clause: 
‘‘(iii) 
TRANSITIONAL
ADJUSTMENT 
FOR DUAL ELIGIBLES AND SOCIOECONOMIC 
STATUS.— 
‘‘(I) IN
GENERAL.—In deter-
mining a hospital’s excess readmission 
ratio under clause (i) for purposes of 
making payments for discharges oc-
curring during fiscal years 2016 and 
2017, and before the initial applica-
tion of clause (iv), and in order to en-
sure that hospitals that treat the most 
vulnerable populations are not un-
fairly penalized by the program under 
this subsection, the Secretary shall 
provide for such risk adjustment as 
will take into account both a hos-
pital’s proportion of inpatients who 
are full-benefit dual eligible individ-
uals (as defined in section 1935(c)(6)) 
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and the socioeconomic status of the 
patients served by the hospital. 
‘‘(II) QUANTITATIVE METHOD.— 
For purposes of applying subclause 
(I)(bb), the Secretary, to the max-
imum extent practicable, shall utilize 
the most recent data available from 
the Bureau of the Census in order to 
develop a quantitative method to ad-
just for socioeconomic status. In de-
veloping such quantitative method, the 
Secretary— 
‘‘(aa) shall, to the maximum 
extent practicable, use inputs 
that address at least income, 
education level, or poverty rate; 
and 
‘‘(bb) may include inputs 
that address other socioeconomic 
and sociodemographic factors de-
termined appropriate by the Sec-
retary. 
‘‘(III) PATIENTS SERVED BY THE 
HOSPITAL.—For purposes of sub-
clause (I)(bb), the Secretary shall, to 
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the 
maximum 
extent 
practicable, 
measure the socioeconomic status for 
all patients served by each hospital. 
The Secretary may supplement incom-
plete or inaccessible patient-level data 
with data related to the geographic re-
gion of the patients served by the hos-
pital. 
‘‘(IV) MINIMIZING
REPORTING 
BURDEN ON HOSPITALS.—In carrying 
out this clause, the Secretary shall not 
impose any additional reporting re-
quirements on hospitals.’’. 
(b) SUBSEQUENT ADJUSTMENTS BASED
ON IM-
PACT AND MEDPAC REPORTS.—Section 1886(q)(4)(C) 
of the Social Security Act (42 U.S.C. 1395ww(q)(4)(C)) 
is further amended by adding at the end the following new 
clause: 
‘‘(iv) RISK ADJUSTMENTS UNDER RE-
ADMISSION
PROGRAM
BASED
ON
IMPACT 
AND MEDPAC REPORTS.—In making rec-
ommendations under subparagraph (D) of 
section 2(d)(1) of the IMPACT Act of 
2014 (Public Law 113–185; 42 U.S.C. 
1395lll note) with respect to the applica-
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tion of risk adjustment under this sub-
section, the Secretary is required to base 
such risk adjustment on the reports sub-
mitted under subparagraphs (A)(ii) and 
(B)(ii) of such section as well as on the re-
port submitted by the Medicare Payment 
Advisory Commission under section 2(c) of 
the Establishing Beneficiary Equity in the 
Hospital Readmission Program Act of 
2015. The Administrator of the Centers 
for Medicare & Medicaid Services shall in-
corporate such recommendations in car-
rying out risk adjustment under this sub-
section for discharges occurring in fiscal 
years after fiscal year 2017 in order to en-
sure that hospitals that treat the most vul-
nerable populations are not unfairly penal-
ized by the program under this subsection. 
For fiscal years beginning more than 5 
years after the date of submission of the 
report under section 2(d)(1)(B)(ii) of the 
IMPACT Act of 2014, the Secretary may 
use alternative adjustment mechanisms 
under this subsection to account for socio-
economic factors if the Secretary finds that 
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such measures are better at accounting for 
socioeconomic factors than the mechanisms 
that would otherwise apply.’’. 
(c) MEDPAC STUDY
ON
30-DAY
READMISSION 
THRESHOLD.—The Medicare Payment Advisory Commis-
sion 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)). The Commission shall submit to Con-
gress a report on such study in its report to Congress in 
June 2016. 
(d) ADDRESSING ISSUE
OF NONCOMPLIANT PA-
TIENTS.—Section 1886(q)(4)(C) of the Social Security 
Act (42 U.S.C. 1395ww(q)(4)(C)), as amended by sub-
sections (b) and (c), is further amended by adding at the 
end the following new clause: 
‘‘(v) CONSIDERATION OF EXCLUSION 
OF NONCOMPLIANT PATIENT CASES BASED 
ON V OR OTHER APPROPRIATE CODES.—In 
promulgating regulations to carry out this 
subsection for the applicable period with 
respect to fiscal year 2017, the Secretary 
shall consider the use of V or other ICD- 
related codes for potential exclusions of 
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cases in order to address the issue of non-
compliant patients.’’. 
(e) EXCLUDING CERTAIN CLINICAL CONDITIONS.— 
(1) STUDY.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services shall conduct a 
study, consistent with this paragraph, that as-
sesses and makes recommendations with respect 
to excluding patients whose clinical conditions 
or diagnoses may require frequent hospitaliza-
tions, from the calculation of excess readmis-
sions under section 1886(q)(5)(E) of the Social 
Security Act (42 U.S.C. 1395ww(q)(5)(E)). 
(B) USE
OF
A
TECHNICAL
EXPERT 
PANEL.—The Secretary shall convene a multi- 
stakeholder technical expert panel comprised of 
individuals knowledgeable about clinical care of 
hospitalized patients and quality measurement, 
to provide input and recommendations on the 
study conducted under this paragraph. 
(C) CLINICAL CONDITIONS TO BE CONSID-
ERED.—In conducting the study, the Secretary 
shall consider exclusions for patients with 
transplants, burns, psychosis, and substance 
abuse disorders. The Secretary may include ad-
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ditional clinical conditions where appropriate 
care may require frequent hospitalizations. 
(D) TRANSPARENCY.—The Secretary shall 
make a draft of report on such study available 
for public comment for a period of not less than 
30 days. The final study and recommendations 
shall address the Secretary’s response to public 
comments. 
(E) DEADLINE.—The Secretary shall sub-
mit a final report on the study to Congress no 
later than Oct. 1, 2016. Such final report shall 
include recommendations regarding the relevant 
clinical conditions that should be excluded from 
the calculation of excess readmissions described 
in subparagraph (A). 
(2) APPLICATION TO CALCULATION OF EXCESS 
READMISSIONS.—Beginning with fiscal year 2018, 
the Secretary shall exclude any relevant clinical con-
ditions identified in the recommendations made in 
the final report under paragraph (1)(E) in deter-
mining a hospital’s publicly reported readmission 
rate and excess readmissions ratio under section 
1886(q)(4)(C) of the Social Security Act (42 U.S.C. 
1395ww(q)(4)(C)). The Secretary also is encouraged 
to consider applying the exclusions so identified to 
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other Medicare public reporting and pay-for-per-
formance programs in which readmission measures 
are used. 
(f) BUDGET NEUTRAL IMPLEMENTATION.—The Sec-
retary 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) as may 
be necessary to ensure that the implementation of the this 
section (including the amendments made by this section) 
does not result in an increase in aggregate expenditures 
under such section 1886. 
Æ 
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