,,ii #aadth ,,congress #ast ,session ,s4 #fhh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #aj1 #bjae,mr4 ,manchin 7for himself1 ,mr4 ,portman1 ,mr4 ,wicker1 ,mr4 ,kirk1 ,mr4 ,nelson1 and ,mr4 ,brown7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to adjust the ,medicare hospital readmission reduction program to respond to patient disparities1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,establishing ,beneficiary ,equity in the ,hospital ,readmission ,program ,act of #bjae4 #b4 ,establishing beneficiary equity in the ,medicare hospital readmission program 7a7 ,transitional adjustment for dual eligible population and socioeconomic status ,section #ahhf7q77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#d77;,c77 is amended by adding at the end the following new clause3 7iii7 ,transitional adjustment for dual eligible population and socioeconomic status 7,i7 ,in general ,in determining a hospital's excess readmission ratio under clause 7i7 for purposes of making payments for discharges occurring during fiscal years #bjaf and #bjag1 and before the initial application of clause 7iv71 and in order to ensure that hospitals that treat the most vulnerable populations are not unfairly penalized by the program under this subsection1 the ,secretary shall provide for such risk adjustment as will take into account both a hospital's proportion of inpatients who are full-benefit dual eligible individuals 7as defined in section #aice7;c77#f77 and the socioeconomic status of the patients served by the hospital4 7,,ii7 ,quantitative method ,for purposes of applying subclause 7,i77bb71 the ,secretary1 to the maximum extent practicable1 shall utilize the most recent data available from the ,bureau of the ,census in order to develop a quantitative method to adjust for socioeconomic status4 ,in developing such quantitative method1 the ,secretary-- 7aa7 shall1 to the maximum extent practicable1 use inputs that address at least income1 education level1 or poverty rate2 and 7bb7 may include inputs that address other socioeconomic and sociodemographic factors determined appropriate by the ,secretary4 7,,iii7 ,patients served by the hospital ,for purposes of subclause 7,i77bb71 the ,secretary shall1 to the maximum extent practicable1 measure the socioeconomic status for all patients served by each hospital4 ,the ,secretary may supplement incomplete or inaccessible patient-level data with data related to the geographic region of the patients served by the hospital4 7,,iv7 ,minimizing reporting burden on hospitals ,in carrying out this clause1 the ,secretary shall not impose any additional reporting requirements on hospitals4 4 7b7 ,subsequent adjustments based on ,,impact and ,med,p,a,c reports ,section #ahhf7q77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#d77;,c77 is further amended by adding at the end the following new clause3 7iv7 ,risk adjustments under readmission program based on ,,impact and ,med,p,a,c reports ,in making recommendations under subparagraph 7,d7 of section #b7;d77#a7 of the ,,impact ,act of #bjad 7,public ,law #aac-ahe2 #db ,u4,s4,c4 #acielll note7 with respect to the application of risk adjustment under this subsection1 the ,secretary is required to base such risk adjustment on the reports submitted under subparagraphs 7,a77ii7 and 7,b77ii7 of such section as well as on the report submitted by the ,medicare ,payment ,advisory ,commission under section #b7;c7 of the ,establishing ,beneficiary ,equity in the ,hospital ,readmission ,program ,act of #bjae4 ,the ,administrator of the ,centers for ,medicare ,medicaid ,services shall incorporate such recommendations in carrying out risk adjustment under this subsection for discharges occurring in fiscal years after fiscal year #bjag in order to ensure that hospitals that treat the most vulnerable populations are not unfairly penalized by the program under this subsection4 ,for fiscal years beginning more than #e years after the date of submission of the report under section #b7;d77#a77;,b77ii7 of the ,,impact ,act of #bjad1 the ,secretary may use alternative adjustment mechanisms under this subsection to account for socioeconomic factors if the ,secretary finds that such measures are better at accounting for socioeconomic factors than the mechanisms that would otherwise apply4 4 7c7 ,med,p,a,c study on #cj-;,day readmission threshold ,the ,medicare ,payment ,advisory ,commission shall conduct a study on the appropriateness of using a threshold of #cj days for readmissions under section #ahhf7q77#e77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#e77;,e774 ,the ,commission shall submit to ,congress a report on such study in its report to ,congress in ,june #bjaf4 7d7 ,addressing issue of noncompliant patients ,section #ahhf7q77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#d77;,c771 as amended by subsections 7b7 and 7c71 is further amended by adding at the end the following new clause3 7v7 ,consideration of exclusion of noncompliant patient cases based on ,v or other appropriate codes ,in promulgating regulations to carry out this subsection for the applicable period with respect to fiscal year #bjag1 the ,secretary shall consider the use of ,v or other ,,icd-related codes for potential exclusions of cases in order to address the issue of noncompliant patients4 4 7e7 ,excluding certain clinical conditions 7#a7 ,study 7,a7 ,in general ,the ,secretary of ,health and ,human ,services shall conduct a study1 consistent with this paragraph1 that assesses and makes recommendations with respect to excluding patients whose clinical conditions or diagnoses may require frequent hospitalizations1 from the calculation of excess readmissions under section #ahhf7q77#e77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#e77;,e774 7,b7 ,use of a technical expert panel ,the ,secretary shall convene a multi-stakeholder technical expert panel comprised of individuals knowledgeable about clinical care of hospitalized patients and quality measurement1 to provide input and recommendations on the study conducted under this paragraph4 7,c7 ,clinical conditions to be considered ,in conducting the study1 the ,secretary shall consider exclusions for patients with transplants1 burns1 psychosis1 and substance abuse disorders4 ,the ,secretary may include additional clinical conditions where appropriate care may require frequent hospitalizations4 7,d7 ,transparency ,the ,secretary shall make a draft of report on such study available for public comment for a period of not less than #cj days4 ,the final study and recommendations shall address the ,secretary's response to public comments4 7,e7 ,deadline ,the ,secretary shall submit a final report on the study to ,congress no later than ,oct4 #a1 #bjaf4 ,such final report shall include recommendations regarding the relevant clinical conditions that should be excluded from the calculation of excess readmissions described in subparagraph 7,a74 7#b7 ,application to calculation of excess readmissions ,beginning with fiscal year #bjah1 the ,secretary shall exclude any relevant clinical conditions identified in the recommendations made in the final report under paragraph 7#a77;,e7 in determining a hospital's publicly reported readmission rate and excess readmissions ratio under section #ahhf7q77#d77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77#d77;,c774 ,the ,secretary also is encouraged to consider applying the exclusions so identified to other ,medicare public reporting and pay-for-performance programs in which readmission measures are used4 7f7 ,budget neutral implementation ,the ,secretary of ,health and ,human ,services shall make such payment adjustment to subsection 7d7 hospitals under the inpatient prospective payment system under section #ahhf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7 as may be necessary to ensure that the implementation of the this section 7including the amendments made by this section7 does not result in an increase in aggregate expenditures under such section #ahhf4