[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[S. 3116 Introduced in Senate (IS)]
110th CONGRESS
2d Session
S. 3116
To amend title XVIII of the Social Security Act to stabilize and
modernize the provision of partial hospitalization services under the
Medicare program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 11, 2008
Mr. Vitter introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to stabilize and
modernize the provision of partial hospitalization services under the
Medicare program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Outpatient Mental Health
Modernization Act of 2008''.
SEC. 2. TRANSITIONAL FREEZE ON CERTAIN MEDICARE HOSPITAL OUTPATIENT FEE
SCHEDULE AMOUNTS.
Notwithstanding any other provision of law, effective for episodes
and visits beginning on or after January 1, 2009, and before January 1,
2010, in the case of partial hospital services (as defined in section
1861(ff)(1) of the Social Security Act (42 U.S.C. 1395x(ff)(1)), the
OPD fee schedule increase factor under section 1833(t)(3)(C)(iv) of the
Social Security Act (42 U.S.C. 1395l(t)(3)(C)(iv)) for the medicare OPD
fee schedule amount established for such services (as published in the
Federal Register on November 27, 2007 (72 Fed. Reg. 66670)) shall be
zero.
SEC. 3. ACCREDITATION PROGRAM FOR COMMUNITY MENTAL HEALTH CENTERS
PROVIDING PARTIAL HOSPITALIZATION SERVICES.
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is
amended by adding at the end the following new paragraph:
``(18) Accreditation program for community mental health
centers providing partial hospitalization services.--
``(A) Definitions.--In this section:
``(i) Accreditation organization.--The term
`accreditation organization' means an
organization designated by the Secretary under
subparagraph (C)(i)(II) to accredit community
mental health centers providing partial
hospitalization services.
``(ii) Partial hospitalization services.--
The term `partial hospitalization services' has
the meaning given such term in section
1861(ff)(1).
``(iii) Physician.--Except as otherwise
provided by the Secretary, the term `physician'
means any individual who furnishes services for
which payment may be made under the physician
fee schedule under section 1848.
``(iv) Physician specialty organization.--
The term `physician specialty organization'
means a United States medical specialty society
that represents diplomats certified by a board
recognized by the American Board of Medical
Specialties.
``(B) Establishment.--Not later than January 1,
2010, subject to the succeeding provisions of this
paragraph, the Secretary shall, by regulation,
establish an accreditation program which requires the
accreditation of community mental health centers
providing partial hospitalization services.
``(C) Design of accreditation program.--
``(i) In general.--Each community mental
health center providing partial hospitalization
services for which payment is made under the
prospective payment system established under
this subsection must be accredited for each
program under which such services are furnished
by the community mental health center by an
accrediting organization designated by the
Secretary under clause (ii).
``(ii) Accreditation organizations.--
``(I) In general.--The Secretary
shall, by regulation, designate
entities to accredit community mental
health centers providing partial
hospitalization services. The entities
designated under the preceding sentence
shall include the Joint Commission on
Accreditation of Hospitals and the
Commission on Accreditation of
Rehabilitation Facilities.
``(II) Consultation.--In
designating entities under subclause
(I), the Secretary shall consult with
academic medical centers, community
mental health centers, hospitals, and
other appropriate medical personnel
(such as psychologists, social workers,
and nurse specialists).
``(iii) Considerations.--In designating
entities under clause (ii), the Secretary shall
consider the following:
``(I) The ability of the entity to
conduct timely reviews of accreditation
applications.
``(II) Whether the entity has
established a process for the timely
integration of new services and
clinical interventions for individuals
who are furnished partial
hospitalization services.
``(III) Any other factors the
Secretary determines appropriate.
``(iv) Use of criteria for accreditation.--
Accreditation organizations shall use
appropriate criteria for evaluating community
mental health centers providing partial
hospitalization services for purposes of the
accreditation of such community mental health
centers, including criteria with respect to--
``(I) the qualifications of
nonphysician medical personnel;
``(II) the qualifications and
responsibilities of physicians,
including supervising physicians;
``(III) the establishment of
procedures for ensuring patient safety;
and
``(IV) quality assurance reporting.
``(v) Incorporation of quality measures.--
Not later than January 1, 2012, the Secretary
shall provide for the incorporation of measures
selected for purposes of quality reporting
under paragraph (19) into the accreditation
program established under this paragraph,
including the use of such measures in the
criteria for accreditation under clause (iv).
``(vi) Review of accreditation
organizations.--The Secretary, in consultation
with the entities and individuals described in
clause (ii)(II)--
``(I) shall conduct an annual
review of accreditation organizations
designated under clause (ii); and
``(II) may, by regulation, expand
the original list of accreditation
organizations so designated.
``(D) Evaluation and report.--
``(i) Evaluation.--The Secretary shall
contract with an independent, private
organization or entity to evaluate the effect
of the accreditation program established under
this paragraph and other relevant questions
involving access to and value of partial
hospitalization services furnished to
individuals under this part. Such evaluation
shall examine the following:
``(I) The impact of accreditation
requirements on the number, type, and
quality of partial hospitalization
services furnished to individuals under
this part.
``(II) The cost of meeting such
accreditation requirements, including
an examination of compliance costs to
community mental health centers
providing partial hospitalization
services and administrative costs to
the Secretary.
``(III) The access of individuals
under this part to partial
hospitalization services, especially in
rural areas, before and after
implementation of the accreditation
program.
``(IV) Any other matters the
Secretary determines appropriate.
``(ii) Report.--Not later than December 31,
2012, the Secretary shall submit a report to
Congress on the evaluation conducted under
clause (i).
``(E) Waiver authority.--The Secretary shall waive
compliance with the requirements of this title to such
extent and for such period as the Secretary determines
is necessary to carry out this paragraph.''.
SEC. 4. QUALITY IMPROVEMENT FOR PARTIAL HOSPITALIZATION SERVICES
PROVIDED BY COMMUNITY MENTAL HEALTH CENTERS.
Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)), as
amended by section 3, is amended by adding at the end the following new
paragraph:
``(19) Quality reporting for partial hospitalization
services provided by community mental health centers.--
``(A) Reduction in update for failure to report.--
For purposes of paragraph (3)(C)(iv) for 2009 and each
subsequent year, in the case of a community mental
health center providing partial hospitalization
services (as defined in section 1861(ff)(1)) that does
not submit, to the Secretary in accordance with this
paragraph, data required to be submitted on measures
selected under this paragraph with respect to such a
calendar year, the OPD fee schedule increase factor
under paragraph (3)(C)(iv) for such year shall be
reduced by 1.0 percentage point. A reduction under the
preceding sentence shall apply only with respect to the
year involved and the Secretary shall not take into
account such reduction in computing the OPD fee
schedule increase factor for a subsequent calendar
year.
``(B) Form and manner of submission.--
``(i) In general.--Subject to clause (ii),
each community mental health center providing
partial hospitalization services shall submit
to the Secretary data on measures selected
under this paragraph in a form and manner, and
at a time, specified by the Secretary for
purposes of this paragraph.
``(ii) Grace period for submission in
2011.--In the case of such data submitted with
respect to 2011, the Secretary shall provide
for a 30-day grace period for the submission of
such data by a community mental health center
providing partial hospitalization services.
``(C) Development of measures.--
``(i) In general.--The Secretary shall
select measures that the Secretary determines
appropriate for the measurement of the quality
of care provided by community mental health
centers providing partial hospitalization
services, including, beginning with 2011,
measures for a set of 5 indicators established
by the Secretary.
``(ii) Additional measures.--The Secretary
shall expand, beyond the measures selected
under clause (i) and consistent with the
succeeding provisions of this paragraph, the
set of measures that the Secretary determines
appropriate for the measurement of the quality
of care provided by community mental health
centers providing partial hospitalization
services.
``(iii) Consensus measures.--Beginning with
2009, the Secretary shall add additional
measures that reflect consensus among affected
parties and, to the extent feasible and
practicable, shall include measures set forth
by 1 or more national consensus building
entities.
``(D) Replacement of measures.--For purposes of
this paragraph, the Secretary may replace any measures
or indicators in appropriate cases, such as where all
community mental health centers providing partial
hospitalization services are effectively in compliance
or the measures or indicators have been subsequently
shown not to represent the best clinical practice.
``(E) Availability of data.--The Secretary shall
establish procedures for making data submitted under
this paragraph available to the public. Such procedures
shall ensure that a community mental health center
providing partial hospitalization services has the
opportunity to review the data that are to be made
public with respect to the community mental health
center prior to such data being made public. The
Secretary shall report quality measures of process,
structure, outcome, patients' perspectives on care,
efficiency, and costs of care that relate to partial
hospitalization services on the Internet website of the
Centers for Medicare & Medicaid Services.''.
SEC. 5. ESTABLISHING MINIMUM NUMBER OF SERVICE UNITS.
(a) In General.--Section 1861(ff)(3)(A) of the Social Security Act
(42 U.S.C. 1395x(ff)(3)(A)) is amended--
(1) by striking ``, and'' and inserting a comma; and
(2) by inserting before the period at the end ``, and which
provides a minimum of 4 units of items and services described
in paragraph (2)''.
(b) Effective Date.--The amendments made by this section shall take
effect on January 1, 2011.
SEC. 6. COST-REPORTS OF PROVIDERS OF PARTIAL HOSPITALIZATION SERVICES.
(a) In General.--The Secretary shall require fiscal intermediaries
under the Medicare program under title XVIII of the Social Security Act
to file the cost reports of providers of partial hospitalization
services (as defined in section 1861(ff)(1) of the Social Security Act
(42 U.S.C. 1395x(ff)(1)) into the Healthcare Provider Cost Reporting
Information System (HCRIS) maintained by the Centers for Medicare &
Medicaid Services.
(b) Funding.--Out of any funds in the Treasury not otherwise
appropriated, there are appropriated $1,000,000 to the Secretary of
Health and Human Services for calendar year 2009 to carry out this
section.
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