,,ii  #aad? ,,congress  #a/ ,session    
,s4 #fhh  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #aj1 #bjae,mr4    
,man*9 7= himself1 ,mr4 ,portman1 ,mr4  
,wick]1 ,mr4 ,kirk1 ,mr4 ,nelson1 & ,mr4
 ,br[n7 introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
adju/ ! ,m$ic>e hospital readmission    
r$uction program to respond to pati5t   
disp>ities1 & = o!r purposes4  #a4 ,%ort
 title ,?is ,act may be cit$ z !        
,e/abli%+ ,b5efici>y ,equity 9 !        
,hospital ,readmission ,program ,act (  
#bjae4  #b4 ,e/abli%+ b5efici>y equity 9
 ! ,m$ic>e hospital readmission program 
7a7 ,transitional adju/m5t = dual       
eligible population & socioeconomic     
/atus ,section #ahhf7q77#d77;,c7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7q77#d77;,c77 is am5d$ by add+ at
 ! end ! foll[+ new clause3  7iii7      
,transitional adju/m5t = dual eligible  
population & socioeconomic /atus  7,i7  

,9 g5]al ,9 det]m9+ a hospital's excess 
readmission ratio "u clause 7i7 =       
purposes ( mak+ paym5ts = dis*>ges      
occurr+ dur+ fiscal ye>s #bjaf & #bjag1 
& be=e ! initial application ( clause   
7iv71 & 9 ord] to ensure t hospitals t  
treat ! mo/ vuln]able populations are n 
unfairly p5aliz$ by ! program "u ?is    
subsection1 ! ,secret>y %all provide =  
su* risk adju/m5t z w take into acc\nt  
bo? a hospital's proportion ( inpati5ts 
:o are full-b5efit dual eligible        
individuals 7z def9$ 9 section          
#aice7;c77#f77 & ! socioeconomic /atus (
 ! pati5ts s]v$ by ! hospital4  7,,ii7  
,quantitative me?od ,= purposes ( apply+
 subclause 7,i77bb71 ! ,secret>y1 to !  
maximum ext5t practicable1 %all utilize 
! mo/ rec5t data available f ! ,bureau (
 ! ,c5sus 9 ord] to develop a           
quantitative me?od to adju/ =           
socioeconomic /atus4 ,9 develop+ su*    
quantitative me?od1 ! ,secret>y--  7aa7 
%all1 to ! maximum ext5t practicable1   
use inputs t address at lea/ income1    

education level1 or pov]ty rate2 &  7bb7
 may include inputs t address o!r       
socioeconomic & sociodemographic factors
 det]m9$ appropriate by ! ,secret>y4    
7,,iii7 ,pati5ts s]v$ by ! hospital ,=  
purposes ( subclause 7,i77bb71 !        
,secret>y %all1 to ! maximum ext5t      
practicable1 measure ! socioeconomic    
/atus = all pati5ts s]v$ by ea*         
hospital4 ,! ,secret>y may supplem5t    
incomplete or inaccessible pati5t-level 
data ) data relat$ to ! geographic      
region ( ! pati5ts s]v$ by ! hospital4  
7,,iv7 ,m9imiz+ report+ burd5 on        
hospitals ,9 c>ry+ out ?is clause1 !    
,secret>y %all n impose any additional  
report+ requirem5ts on hospitals4  4    
7b7 ,subsequ5t adju/m5ts bas$ on        
,,impact & ,med,p,a,c reports ,section  
#ahhf7q77#d77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acieww7q77#d77;,c77
 is fur!r am5d$ by add+ at ! end !      
foll[+ new clause3  7iv7 ,risk adju/m5ts
 "u readmission program bas$ on ,,impact
 & ,med,p,a,c reports ,9 mak+           

recomm5dations "u subp>agraph 7,d7 (    
section #b7;d77#a7 ( ! ,,impact ,act (  
#bjad 7,public ,law #aac-ahe2 #db       
,u4,s4,c4 #acielll note7 ) respect to ! 
application ( risk adju/m5t "u ?is      
subsection1 ! ,secret>y is requir$ to   
base su* risk adju/m5t on ! reports     
submitt$ "u subp>agraphs 7,a77ii7 &     
7,b77ii7 ( su* section z well z on !    
report submitt$ by ! ,m$ic>e ,paym5t    
,advisory ,commission "u section #b7;c7 
( ! ,e/abli%+ ,b5efici>y ,equity 9 !    
,hospital ,readmission ,program ,act (  
#bjae4 ,! ,adm9i/rator ( ! ,c5t]s =     
,m$ic>e  ,m$icaid ,s]vices %all         
incorporate su* recomm5dations 9 c>ry+  
out risk adju/m5t "u ?is subsection =   
dis*>ges occurr+ 9 fiscal ye>s aft]     
fiscal ye> #bjag 9 ord] to ensure t     
hospitals t treat ! mo/ vuln]able       
populations are n unfairly p5aliz$ by ! 
program "u ?is subsection4 ,= fiscal    
ye>s beg9n+ m ?an #e ye>s aft] ! date ( 
submission ( ! report "u section        
#b7;d77#a77;,b77ii7 ( ! ,,impact ,act ( 

#bjad1 ! ,secret>y may use alt]native   
adju/m5t me*anisms "u ?is subsection to 
acc\nt = socioeconomic factors if !     
,secret>y f9ds t su* measures are bett] 
at acc\nt+ = socioeconomic factors ?an !
 me*anisms t w\ld o!rwise apply4  4  7c7
 ,med,p,a,c /udy on #cj-;,day           
readmission ?re%old ,! ,m$ic>e ,paym5t  
,advisory ,commission %all conduct a    
/udy on ! appropriat5ess ( us+ a ?re%old
 ( #cj days = readmissions "u section   
#ahhf7q77#e77;,e7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4                     
#acieww7q77#e77;,e774 ,! ,commission    
%all submit to ,congress a report on su*
 /udy 9 its report to ,congress 9 ,june 
#bjaf4  7d7 ,address+ issue (           
noncompliant pati5ts ,section           
#ahhf7q77#d77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4                     
#acieww7q77#d77;,c771 z am5d$ by        
subsections 7b7 & 7c71 is fur!r am5d$ by
 add+ at ! end ! foll[+ new clause3  7v7
 ,consid]ation ( exclusion (            
noncompliant pati5t cases bas$ on ,v or 

o!r appropriate codes ,9 promulgat+     
regulations to c>ry out ?is subsection =
 ! applicable p]iod ) respect to fiscal 
ye> #bjag1 ! ,secret>y %all consid] !   
use ( ,v or o!r ,,icd-relat$ codes =    
pot5tial exclusions ( cases 9 ord] to   
address ! issue ( noncompliant pati5ts4 
4  7e7 ,exclud+ c]ta9 cl9ical conditions
  7#a7 ,/udy  7,a7 ,9 g5]al ,! ,secret>y
 ( ,heal? & ,human ,s]vices %all conduct
 a /udy1 consi/5t ) ?is p>agraph1 t     
assesses & makes recomm5dations )       
respect to exclud+ pati5ts ^: cl9ical   
conditions or diagnoses may require     
frequ5t hospitalizations1 f !           
calculation ( excess readmissions "u    
section #ahhf7q77#e77;,e7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acieww7q77#e77;,e774  7,b7 ,use ( a    
te*nical exp]t panel ,! ,secret>y %all  
conv5e a multi-/akehold] te*nical exp]t 
panel compris$ ( individuals kn[l$geable
 ab\t cl9ical c>e ( hospitaliz$ pati5ts 
& quality measurem5t1 to provide input &
 recomm5dations on ! /udy conduct$ "u   

?is p>agraph4  7,c7 ,cl9ical conditions 
to be consid]$ ,9 conduct+ ! /udy1 !    
,secret>y %all consid] exclusions =     
pati5ts ) transplants1 burns1 psy*osis1 
& sub/ance abuse disord]s4 ,! ,secret>y 
may include additional cl9ical          
conditions :]e appropriate c>e may      
require frequ5t hospitalizations4  7,d7 
,transp>5cy ,! ,secret>y %all make a    
draft ( report on su* /udy available =  
public comm5t = a p]iod ( n less ?an #cj
 days4 ,! f9al /udy & recomm5dations    
%all address ! ,secret>y's response to  
public comm5ts4  7,e7 ,deadl9e ,!       
,secret>y %all submit a f9al report on !
 /udy to ,congress no lat] ?an ,oct4 #a1
 #bjaf4 ,su* f9al report %all include   
recomm5dations reg>d+ ! relevant cl9ical
 conditions t %\ld be exclud$ f !       
calculation ( excess readmissions       
describ$ 9 subp>agraph 7,a74  7#b7      
,application to calculation ( excess    
readmissions ,beg9n+ ) fiscal ye> #bjah1
 ! ,secret>y %all exclude any relevant  
cl9ical conditions id5tifi$ 9 !         

recomm5dations made 9 ! f9al report "u  
p>agraph 7#a77;,e7 9 det]m9+ a          
hospital's publicly report$ readmission 
rate & excess readmissions ratio "u     
section #ahhf7q77#d77;,c7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acieww7q77#d77;,c774 ,! ,secret>y also 
is enc\rag$ to consid] apply+ !         
exclusions s id5tifi$ to o!r ,m$ic>e    
public report+ & pay-=-p]=mance programs
 9 :i* readmission measures are us$4    
7f7 ,budget neutral implem5tation ,!    
,secret>y ( ,heal? & ,human ,s]vices    
%all make su* paym5t adju/m5t to        
subsection 7d7 hospitals "u ! inpati5t  
prospective paym5t sy/em "u section     
#ahhf ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acieww7 z may be necess>y to 
ensure t ! implem5tation ( ! ?is section
 7includ+ ! am5dm5ts made by ?is        
section7 does n result 9 an increase 9  
aggregate exp5ditures "u su* section    
#ahhf4