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. JOHN-
SON of Ohio, Mr. CARNEY, Mr. JOHNSON of Georgia, Mr. ENGEL, Ms. 
KAPTUR, Mr. DAVID SCOTT of Georgia, and Ms. EDDIE BERNICE JOHN-
SON 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. 
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’’. 
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SEC. 2. ADJUSTING THE MEDICARE HOSPITAL READMIS-
SION 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)) is amended by adding at the end the 
following: ‘‘Such term does not include an admission that 
is classified within one or more of the following: trans-
plants, end-stage renal disease, burns, trauma, psychosis, 
or substance abuse.’’. 
(b) ADJUSTMENT
FOR
DUAL
ELIGIBLE
POPU-
LATION.—Section 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) ADJUSTMENT FOR DUAL ELIGI-
BLES.—In applying clause (i), the Sec-
retary shall provide for such risk adjust-
ment as will take into account a hospital’s 
proportion of inpatients who are full-ben-
efit 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 Commis-
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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 2014. 
(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-
section (b), is further amended by adding at the end the 
following new clause: 
‘‘(iv) CONSIDERATION OF EXCLUSION 
OF NONCOMPLIANT PATIENT CASES BASED 
ON V CODES.—In promulgating regulations 
to carry out this subsection for the applica-
ble 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 IMPLE-
MENTATION.— 
(1) The amendments made by this section shall 
be effective for applicable periods with respect to fis-
cal year 2015 and each succeeding fiscal year. 
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(2) The Secretary of Health and Human Serv-
ices shall make such payment adjustment to sub-
section (d) hospitals under the inpatient prospective 
payment system under section 1886 of the Social 
Security Act (42 U.S.C. 1395ww) as may be nec-
essary to ensure that the implementation of the 
amendments made by this section do not result in an 
increase in aggregate expenditures under such sec-
tion. 
Æ 
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