This bill would implement a number of reforms to Medicare’s payment system aimed at helping hospitals better serve their patients, particularly in low-income communities, in addition to updating how Medicare enrollment data is reported.
The Dept. of Health and Human Services (HHS) would be required to change the Hospital Readmissions Reduction Program to ensure that hospitals serving low-income patients aren’t penalized by being compared to hospitals with a dissimilar patientbase. Currently the calculation doesn’t account for disparities in the frequency of hospital visits by different socioeconomic groups, which punishes hospitals serving lower-income patients.
Hospital outpatient departments (HOPD) classified as “mid-build” would be required to certify that they’re provider-based to HHS, which would be responsible for auditing those claims to receive the full HOPD payment rate rather than a lower fee schedule. Essentially, this lets hospitals that were building HOPDs when a November 2015 change occurred to bill Medicare, even though current law would have otherwise prevented them from doing so.
HHS’ ability to terminate Medicare Advantage (MA) contracts based on a failure to achieve minimum quality ratings under the MA STARS rating system would be delayed for three years. The Centers for Medicare and Medicaid Services (CMS) could still terminate plans for the 10 other performance categories included in a Past Cycle Performance Review.
HHS would be required to publish Medicare enrollment data by Congressional District, zip code, and state each year. This would include MA, Part D, plus fee-for-service enrollment data, and comprehensive enrollment report for Medicare no later than June 1 of each calendar year with the preceding year’s data.