Inpatient Psychiatric Facility Improvement Act
Bill: H.R.8879 | Sponsor: Rep. Evans, Dwight (D-PA)
Policy area: Health

Summary:
Inpatient Psychiatric Facility Improvement Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to revise payments under the Medicare prospective payment system for psychiatric hospitals and psychiatric units based on newly collected data, which may include data on charges, the required intensity of behavioral monitoring, and interventions. Psychiatric hospitals and units must also submit patient assessment data through a standardized instrument developed by the CMS.

To amend title XVIII of the Social Security Act to provide for 
improvements to the Medicare prospective payment system for psychiatric 
                    hospitals and psychiatric units.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Inpatient Psychiatric Facility 
Improvement Act''.

SEC. 2. IMPROVEMENTS TO MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR 
              PSYCHIATRIC HOSPITALS AND PSYCHIATRIC UNITS.

    (a) Improvements Through Additional Claims Data Information.--
Section 1886(s) of the Social Security Act (42 U.S.C. 1395ww(s)) is 
amended by adding at the end the following new paragraph:
            ``(5) Additional data and information.--
                    ``(A) In general.--The Secretary shall collect data 
                and information as the Secretary determines appropriate 
                to revise payments under the system described in 
                paragraph (1) for psychiatric hospitals and psychiatric 
                units pursuant to subparagraph (D) and for other 
                purposes as determined appropriate by the Secretary. 
                The Secretary shall begin to collect such data by not 
                later than October 1, 2023.
                    ``(B) Data and information.--The data and 
                information to be collected under subparagraph (A) may 
                include--
                            ``(i) charges, including those related to 
                        ancillary services;
                            ``(ii) the required intensity of behavioral 
                        monitoring, such as cognitive deficit, suicide 
                        ideations, violent behavior, and need for 
                        physical restraint; and
                            ``(iii) interventions, such as 
                        detoxification services for substance abuse, 
                        dependence on respirator, total parenteral 
                        nutritional support, dependence on renal 
                        dialysis, and burn care.
                    ``(C) Method of collection.--The Secretary may 
                collect the additional data and information under 
                subparagraph (A) on cost reports or claims.
                    ``(D) Revisions to payment rates.--
                            ``(i) In general.--Notwithstanding the 
                        preceding paragraphs of this subsection or 
                        section 124 of the Medicare, Medicaid, and 
                        SCHIP Balanced Budget Refinement Act of 1999, 
                        for rate year 2025 (and for any subsequent rate 
                        year, if determined appropriate by the 
                        Secretary), the Secretary shall, by regulation, 
                        implement revisions to the methodology for 
                        determining the payment rates under the system 
                        described in paragraph (1) for psychiatric 
                        hospitals and psychiatric units, as the 
                        Secretary determines to be appropriate. Such 
                        revisions may be based on a review of data and 
                        information collected under subparagraph (A).
                            ``(ii) Review.--The Secretary may make 
                        revisions to the diagnosis-related group 
                        classifications, in accordance with subsection 
                        (d)(4)(C), to reflect nursing and staff 
                        resource use and costs involved in furnishing 
                        services at such hospitals and units, including 
                        considerations for patient complexity and prior 
                        admission to an inpatient psychiatric facility, 
                        which may be based on review of data and 
                        information collected under subparagraph (A), 
                        as the Secretary determines to be appropriate.
                            ``(iii) Budget neutrality.--Revisions in 
                        payment implemented pursuant to clause (i) for 
                        a rate year shall result in the same estimated 
                        amount of aggregate expenditures under this 
                        title for psychiatric hospitals and psychiatric 
                        units furnished in the rate year as would have 
                        been made under this title for such care in 
                        such rate year if such revisions had not been 
                        implemented.''.
    (b) Improvements Through Standardized Patient Assessment Data.--
Section 1886(s) of the Social Security Act (42 U.S.C. 1395ww(s)), as 
amended by subsection (a), is further amended--
            (1) in paragraph (4)--
                    (A) in subparagraph (A)(i), by striking 
                ``subparagraph (C)'' and inserting ``subparagraphs (C) 
                and (E)'';
                    (B) by redesignating subparagraph (E) as 
                subparagraph (F);
                    (C) by inserting after subparagraph (D) the 
                following new subparagraph:
                    ``(E) Standardized patient assessment data.--
                            ``(i) In general.--For rate year 2028 and 
                        each subsequent rate year, in addition to such 
                        data on the quality measures described in 
                        subparagraph (C), each psychiatric hospital and 
                        psychiatric unit shall submit to the Secretary, 
                        through the use of a standardized assessment 
                        instrument implemented under clause (iii), the 
                        standardized patient assessment data described 
                        in clause (ii). Such data shall be submitted 
                        with respect to admission and discharge of an 
                        individual (and may be submitted more 
                        frequently as the Secretary determines 
                        appropriate).
                            ``(ii) Standardized patient assessment data 
                        described.--For purposes of clause (i), the 
                        standardized patient assessment data described 
                        in this clause, with respect to a psychiatric 
                        hospital or psychiatric unit, is data with 
                        respect to the following categories:
                                    ``(I) Functional status, such as 
                                mobility and self-care at admission to 
                                a psychiatric hospital or unit and 
                                before discharge from a psychiatric 
                                hospital or unit.
                                    ``(II) Cognitive function, such as 
                                ability to express ideas and to 
                                understand, and mental status, such as 
                                depression and dementia.
                                    ``(III) Special services, 
                                treatments, and interventions for 
                                psychiatric conditions.
                                    ``(IV) Medical conditions and co-
                                morbidities, such as diabetes, 
                                congestive heart failure, and pressure 
                                ulcers.
                                    ``(V) Impairments, such as 
                                incontinence and an impaired ability to 
                                hear, see, or swallow.
                                    ``(VI) Other categories as 
                                determined appropriate by the 
                                Secretary.
                            ``(iii) Standardized assessment 
                        instrument.--
                                    ``(I) In general.--For purposes of 
                                clause (i), the Secretary shall 
                                implement a standardized assessment 
                                instrument that provides for the 
                                submission of standardized patient 
                                assessment data under this title with 
                                respect to psychiatric hospitals and 
                                psychiatric units which enables 
                                comparison of such assessment data 
                                across all such hospitals and units to 
                                which such data are applicable.
                                    ``(II) Funding.--The Secretary 
                                shall provide for the transfer, from 
                                the Federal Hospital Insurance Trust 
                                Fund under section 1817 to the Centers 
                                for Medicare & Medicaid Services 
                                Program Management Account, of 
                                $10,000,000 for purposes of carrying 
                                out subclause (I).''; and
                    (D) in subparagraph (F), as redesignated by 
                subparagraph (B) of this paragraph, by striking 
                ``subparagraph (C)'' and inserting ``subparagraphs (C) 
                and (F)''; and
            (2) by adding at the end the following new paragraph:
            ``(6) Additional considerations for diagnosis-related group 
        classifications.--
                    ``(A) In general.--Notwithstanding the preceding 
                paragraphs of this subsection (other than paragraph 
                (5)) or section 124 of the Medicare, Medicaid, and 
                SCHIP Balanced Budget Refinement Act of 1999, beginning 
                not later than rate year 2031, in addition to any 
                revisions pursuant to paragraph (5), the Secretary 
                shall, by regulation, implement revisions to the 
                methodology for determining the payment rates under the 
                system described in paragraph (1) for psychiatric 
                hospitals and psychiatric units, as the Secretary 
                determines to be appropriate, to take into account the 
                patient assessment data described in paragraph 
                (4)(E)(ii).
                    ``(B) Budget neutrality.--Revisions in payment 
                implemented pursuant to subparagraph (A) for a rate 
                year shall result in the same estimated amount of 
                aggregate expenditures under this title for psychiatric 
                hospitals and psychiatric units furnished in the rate 
                year as would have been made under this title for such 
                care in such rate year if such revisions had not been 
                implemented.''.
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