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US Laws | Affordable Health Care Act (HR3950F)
TITLE X--STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS
Subtitle C--Provisions Relating to Title III

(c) Floor for Practice Expense Index for Physicians" Services Furnished in Frontier States- Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-4(e)(1)), as amended by section 3102, is amended-- (13296)

(1) in subparagraph (A), by striking "and (H)" and inserting "(H), and (I)"; and (13297)

(2) by adding at the end the following new subparagraph: (13298)

"(I) FLOOR FOR PRACTICE EXPENSE INDEX FOR SERVICES FURNISHED IN FRONTIER STATES- (13299)

"(i) IN GENERAL- Subject to clause (ii), for purposes of payment for services furnished in a frontier State (as defined in section 1886(d)(3)(E)(iii)(II)) on or after January 1, 2011, after calculating the practice expense index in subparagraph (A)(i), the Secretary shall increase any such index to 1.00 if such index would otherwise be less that 1.00. The preceding sentence shall not be applied in a budget neutral manner. (13300)

"(ii) LIMITATION- This subparagraph shall not apply to services furnished in a State that receives a non-labor related share adjustment under section 1886(d)(5)(H).". (13301)

SEC. 10325. REVISION TO SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM. (13302)(Text)

(a) Temporary Delay of RUG-IV- Notwithstanding any other provision of law, the Secretary of Health and Human Services shall not, prior to October 1, 2011, implement Version 4 of the Resource Utilization Groups (in this subsection refereed to as "RUG-IV") published in the Federal Register on August 11, 2009, entitled "Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2010; Minimum Data Set, Version 3.0 for Skilled Nursing Facilities and Medicaid Nursing Facilities" (74 Fed. Reg. 40288). Beginning on October 1, 2010, the Secretary of Health and Human Services shall implement the change specific to therapy furnished on a concurrent basis that is a component of RUG-IV and changes to the lookback period to ensure that only those services furnished after admission to a skilled nursing facility are used as factors in determining a case mix classification under the skilled nursing facility prospective payment system under section 1888(e) of the Social Security Act (42 U.S.C. 1395yy(e)). (13303)

(b) Construction- Nothing in this section shall be interpreted as delaying the implementation of Version 3.0 of the Minimum Data Sets (MDS 3.0) beyond the planned implementation date of October 1, 2010. (13304)

SEC. 10326. PILOT TESTING PAY-FOR-PERFORMANCE PROGRAMS FOR CERTAIN MEDICARE PROVIDERS. (13305)(Text)

(a) In General- Not later than January 1, 2016, the Secretary of Health and Human Services (in this section referred to as the "Secretary") shall, for each provider described in subsection (b), conduct a separate pilot program under title XVIII of the Social Security Act to test the implementation of a value-based purchasing program for payments under such title for the provider. (13306)

(b) Providers Described- The providers described in this paragraph are the following: (13307)

(1) Psychiatric hospitals (as described in clause (i) of section 1886(d)(1)(B) of such Act (42 U.S.C. 1395ww(d)(1)(B))) and psychiatric units (as described in the matter following clause (v) of such section). (13308)

(2) Long-term care hospitals (as described in clause (iv) of such section). (13309)

(3) Rehabilitation hospitals (as described in clause (ii) of such section). (13310)

(4) PPS-exempt cancer hospitals (as described in clause (v) of such section). (13311)

(5) Hospice programs (as defined in section 1861(dd)(2) of such Act (42 U.S.C. 1395x(dd)(2))). (13312)

(c) Waiver Authority- The Secretary may waive such requirements of titles XI and XVIII of the Social Security Act as may be necessary solely for purposes of carrying out the pilot programs under this section. (13313)

(d) No Additional Program Expenditures- Payments under this section under the separate pilot program for value based purchasing (as described in subsection (a)) for each provider type described in paragraphs (1) through (5) of subsection (b) for applicable items and services under title XVIII of the Social Security Act for a year shall be established in a manner that does not result in spending more under each such value based purchasing program for such year than would otherwise be expended for such provider type for such year if the pilot program were not implemented, as estimated by the Secretary. (13314)

(e) Expansion of Pilot Program- The Secretary may, at any point after January 1, 2018, expand the duration and scope of a pilot program conducted under this subsection, to the extent determined appropriate by the Secretary, if-- (13315)

(1) the Secretary determines that such expansion is expected to-- (13316)

(A) reduce spending under title XVIII of the Social Security Act without reducing the quality of care; or (13317)

(B) improve the quality of care and reduce spending; (13318)

(2) the Chief Actuary of the Centers for Medicare & Medicaid Services certifies that such expansion would reduce program spending under such title XVIII; and (13319)

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