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US Laws | Affordable Health Care Act (HR3950F)
TITLE III--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle B--Improving Medicare for Patients and Providers

(b) Use of Funds- Section 1820(g)(3) of the Social Security Act (42 U.S.C. 1395i-4(g)(3)) is amended-- (4675)

(1) in subparagraph (A), by inserting "and to assist such hospitals in participating in delivery system reforms under the provisions of and amendments made by the Patient Protection and Affordable Care Act, such as value-based purchasing programs, accountable care organizations under section 1899, the National pilot program on payment bundling under section 1866D, and other delivery system reform programs determined appropriate by the Secretary" before the period at the end; and (4676)

(2) in subparagraph (E)-- (4677)

(A) by striking ", and to offset" and inserting ", to offset"; and (4678)

(B) by inserting "and to participate in delivery system reforms under the provisions of and amendments made by the Patient Protection and Affordable Care Act, such as value-based purchasing programs, accountable care organizations under section 1899, the National pilot program on payment bundling under section 1866D, and other delivery system reform programs determined appropriate by the Secretary" before the period at the end. (4679)

(c) Effective Date- The amendments made by this section shall apply to grants made on or after January 1, 2010. (4680)

PART III--IMPROVING PAYMENT ACCURACY (4681)(Text)

SEC. 3131. PAYMENT ADJUSTMENTS FOR HOME HEALTH CARE. (4682)(Text)

(a) Rebasing Home Health Prospective Payment Amount- (4683)

(1) IN GENERAL- Section 1895(b)(3)(A) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(A)) is amended-- (4684)

(A) in clause (i)(III), by striking "For periods" and inserting "Subject to clause (iii), for periods"; and (4685)

(B) by adding at the end the following new clause: (4686)

"(iii) ADJUSTMENT FOR 2013 AND SUBSEQUENT YEARS- (4687)

"(I) IN GENERAL- Subject to subclause (II), for 2013 and subsequent years, the amount (or amounts) that would otherwise be applicable under clause (i)(III) shall be adjusted by a percentage determined appropriate by the Secretary to reflect such factors as changes in the number of visits in an episode, the mix of services in an episode, the level of intensity of services in an episode, the average cost of providing care per episode, and other factors that the Secretary considers to be relevant. In conducting the analysis under the preceding sentence, the Secretary may consider differences between hospital-based and freestanding agencies, between for-profit and nonprofit agencies, and between the resource costs of urban and rural agencies. Such adjustment shall be made before the update under subparagraph (B) is applied for the year. (4688)

"(II) TRANSITION- The Secretary shall provide for a 4-year phase-in (in equal increments) of the adjustment under subclause (I), with such adjustment being fully implemented for 2016. During each year of such phase-in, the amount of any adjustment under subclause (I) for the year may not exceed 3.5 percent of the amount (or amounts) applicable under clause (i)(III) as of the date of enactment of the Patient Protection and Affordable Care Act.". (4689)

(2) MEDPAC STUDY AND REPORT- (4690)

(A) STUDY- The Medicare Payment Advisory Commission shall conduct a study on the implementation of the amendments made by paragraph (1). Such study shall include an analysis of the impact of such amendments on-- (4691)

(i) access to care; (4692)

(ii) quality outcomes; (4693)

(iii) the number of home health agencies; and (4694)

(iv) rural agencies, urban agencies, for-profit agencies, and nonprofit agencies. (4695)

(B) REPORT- Not later than January 1, 2015, the Medicare Payment Advisory Commission shall submit to Congress a report on the study conducted under subparagraph (A), together with recommendations for such legislation and administrative action as the Commission determines appropriate. (4696)

(b) Program-specific Outlier Cap- Section 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)) is amended-- (4697)

(1) in paragraph (3)(C), by striking "the aggregate" and all that follows through the period at the end and inserting "5 percent of the total payments estimated to be made based on the prospective payment system under this subsection for the period."; and (4698)

(2) in paragraph (5)-- (4699)

(A) by striking "OUTLIERS- The Secretary" and inserting the following: "OUTLIERS- (4700)

"(A) IN GENERAL- Subject to subparagraph (B), the Secretary"; (4701)

(B) in subparagraph (A), as added by subparagraph (A), by striking "5 percent" and inserting "2.5 percent"; and (4702)

(C) by adding at the end the following new subparagraph: (4703)

"(B) PROGRAM SPECIFIC OUTLIER CAP- The estimated total amount of additional payments or payment adjustments made under subparagraph (A) with respect to a home health agency for a year (beginning with 2011) may not exceed an amount equal to 10 percent of the estimated total amount of payments made under this section (without regard to this paragraph) with respect to the home health agency for the year.". (4704)

(c) Application of the Medicare Rural Home Health Add-on Policy- Section 421 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2283), as amended by section 5201(b) of the Deficit Reduction Act of 2005 (Public Law 109-171; 120 Stat. 46), is amended-- (4705)

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