I 117th CONGRESS 2d Session H. R. 8879 IN THE HOUSE OF REPRESENTATIVES September 19, 2022 Mr. Evans (for himself and Mr. Arrington ) 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 provide for improvements to the Medicare prospective payment system for psychiatric hospitals and psychiatric units.

1. Short title This Act may be cited as the Inpatient Psychiatric Facility Improvement Act . 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. .