I 
112TH CONGRESS 
1ST SESSION H. R. 3442 
To amend title XVIII of the Social Security Act with respect to payment 
for partial hospitalization services under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 16, 2011 
Ms. EDDIE BERNICE JOHNSON of Texas (for herself, Ms. JACKSON LEE of 
Texas, and Mr. FRANK of Massachusetts) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act with respect 
to payment for partial hospitalization services under the 
Medicare program. 
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 ‘‘Partial Hospitalization 
Stabilization and Integrity Act of 2011’’. 
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SEC. 2. MEDICARE PAYMENT FOR PARTIAL HOSPITALIZA-
TION SERVICES. 
(a) ESTABLISHMENT OF NEW PAYMENT METHOD-
OLOGY.—Section 1833 of the Social Security Act (42 
U.S.C. 1395l) is amended— 
(1) in subsection (a)(2)— 
(A) in subparagraph (B), by striking ‘‘or 
(E)’’ and inserting ‘‘(E), or (I)’’; 
(B) in subparagraph (G), by striking 
‘‘and’’ at the end; 
(C) in subparagraph (H), by striking the 
comma at the end and inserting ‘‘; and’’; and 
(D) by inserting after subparagraph (H) 
the following new subparagraph: 
‘‘(I) with respect to partial hospitalization 
services, the amount determined under sub-
section (z);’’; 
(2) in subsection (t)(2)(B)— 
(A) in clause (iii), by striking ‘‘but’’; 
(B) in clause (iv), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(v) does not include partial hos-
pitalization services.’’; and 
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(3) by adding at the end the following new sub-
section: 
‘‘(z) PAYMENT
FOR
PARTIAL
HOSPITALIZATION 
SERVICES.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish consistent with this subsection a payment sys-
tem for partial hospitalization services. Such pay-
ment system shall be designed to provide for the 
same payment rates without regard to whether the 
services are furnished by a hospital or by a commu-
nity mental health center, to minimize annual fluc-
tuations in overall rates, and to result in an aggre-
gate amount of payment under this part for such 
services during the first 5 years in which this sub-
section is effective equal to the aggregate amount of 
payment that would have been made under this part 
for such services during such period if the Partial 
Hospitalization Stabilization and Integrity Act of 
2011 had not been enacted. 
‘‘(2) DESCRIPTION
OF
SYSTEM.—Under such 
payment system— 
‘‘(A) payments shall be made based on a 
per diem rate (computed consistent with sub-
paragraph (B)) and subject to an annual in-
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crease (consistent with subparagraphs (C) and 
(D) and paragraph (1)); 
‘‘(B) the base per diem rate for services 
furnished in 2011 under this subparagraph 
shall be deemed to be $238.33 for partial hos-
pitalization services (including mental health 
services composite), $82.73 with respect to brief 
individual psychotherapy, $113.05 for extended 
individual psychotherapy, $128.82 for extended 
individual psychotherapy, and $54.87 for group 
psychotherapy; 
‘‘(C) the annual adjustment under this 
subparagraph shall be, subject to subparagraph 
(D) and paragraph (1), a uniform inflation fac-
tor, such as the consumer price index for all 
urban consumers, to be specified by the Sec-
retary; 
‘‘(D) such annual adjustment— 
‘‘(i) if an increase, shall be— 
‘‘(I) provided in full only for 
those providers of partial hospitaliza-
tion services that meet performance 
standards specified by the Secretary 
consistent with the quality service cri-
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teria established under paragraph (3) 
and paragraph (4); and 
‘‘(II) reduced for those providers 
of such services that fail to meet such 
performance standards; and 
‘‘(ii) if a decrease, shall be— 
‘‘(I) provided in full for those 
providers of such services that fail to 
meet such standards; and 
‘‘(II) reduced for those providers 
of such services that meet such stand-
ards; and 
‘‘(E) payment shall not be made for partial 
hospitalization services with a level of care of 
fewer than 4 services per service day. 
‘‘(3) ESTABLISHMENT
OF
QUALITY
SERVICE 
CRITERIA TO JUDGE PERFORMANCE.—In order to 
carry out paragraph (2)(D), the Secretary shall es-
tablish criteria to measure performance of providers 
of partial hospitalization services. Such criteria shall 
include criteria relating to at least the following: 
‘‘(A) ACCESS.—The number of program 
days of scheduled operation from the time of a 
request for services to the first scheduled day of 
service. 
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‘‘(B) TREATMENT
INTENSITY.—The per-
centage of scheduled attendance consistent with 
a minimum attendance average of 4 days per 
calendar week over an episode of care. 
‘‘(C) DISCHARGE
PLANNING.—The per-
centage of patients with a scheduled follow-up 
appointment within 14 days after the date of 
discharge (as needed). 
‘‘(D) CONTINUITY OF CARE.—The percent-
age of post-discharge continuity of care plans 
provided to next level of care providers upon 
discharge. 
‘‘(4) REQUIREMENT FOR ACCREDITATION.—Ef-
fective 2 years after the date of the enactment of 
this subsection, a provider of partial hospitalization 
services shall not be considered to meet performance 
standards under paragraph (2)(D) unless the pro-
vider is accredited by the Joint Commission on Ac-
creditation of Healthcare Organizations, the Com-
mission on Accreditation of Rehabilitation Facilities, 
or such other accreditation body as may be recog-
nized by the Secretary.’’. 
(b) CONFORMING COVERAGE OF MENTAL HEALTH 
SERVICES COMPOSITE FURNISHED BY COMMUNITY MEN-
TAL HEALTH CENTERS.—Under section 1861(ff)(2)(I) of 
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