text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Establishing Beneficiary Equity in 
  the Hospital Readmission Program Act of 2015''.
  
  SEC. 2. ESTABLISHING BENEFICIARY EQUITY IN THE MEDICARE HOSPITAL 
                READMISSION PROGRAM.
  
      (a) Transitional Adjustment for Dual Eligible Population and 
  Socioeconomic Status.--Section 1886(q)(4)(C) of the Social Security Act 
  (42 U.S.C. 1395ww(q)(4)(C)) is amended by adding at the end the 
  following new clause:
                              ``(iii) Transitional adjustment for dual 
                          eligible population and socioeconomic status.--
                                      ``(I) In general.--In determining a 
                                  hospital's excess readmission ratio 
                                  under clause (i) for purposes of making 
                                  payments for discharges occurring 
                                  during fiscal years 2016 and 2017, and 
                                  before the initial application of 
                                  clause (iv), and in order to ensure 
                                  that hospitals that treat the most 
                                  vulnerable populations are not unfairly 
                                  penalized by the program under this 
                                  subsection, 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 (as 
                                  defined in section 1935(c)(6)) and the 
                                  socioeconomic status of the patients 
                                  served by the hospital.
                                      ``(II) Quantitative method.--For 
                                  purposes of applying subclause (I)(bb), 
                                  the Secretary, to the maximum extent 
                                  practicable, shall utilize the most 
                                  recent data available from the Bureau 
                                  of the Census in order to develop a 
                                  quantitative method to adjust for 
                                  socioeconomic status. In developing 
                                  such quantitative method, the 
                                  Secretary--
                                              ``(aa) shall, to the 
                                          maximum extent practicable, use 
                                          inputs that address at least 
                                          income, education level, or 
                                          poverty rate; and
                                              ``(bb) may include inputs 
                                          that address other 
                                          socioeconomic and 
                                          sociodemographic factors 
                                          determined appropriate by the 
                                          Secretary.
                                      ``(III) Patients served by the 
                                  hospital.--For purposes of subclause 
                                  (I)(bb), the Secretary shall, to the 
                                  maximum extent practicable, measure the 
                                  socioeconomic status for all patients 
                                  served by each hospital. The Secretary 
                                  may supplement incomplete or 
                                  inaccessible patient-level data with 
                                  data related to the geographic region 
                                  of the patients served by the hospital.
                                      ``(IV) Minimizing reporting burden 
                                  on hospitals.--In carrying out this 
                                  clause, the Secretary shall not impose 
                                  any additional reporting requirements 
                                  on hospitals.''.
      (b) Subsequent Adjustments Based on IMPACT and MedPAC Reports.--
  Section 1886(q)(4)(C) of the Social Security Act (42 U.S.C. 
  1395ww(q)(4)(C)) is further amended by adding at the end the following 
  new clause:
                              ``(iv) Risk adjustments under readmission 
                          program based on impact and medpac reports.--In 
                          making recommendations under subparagraph (D) 
                          of section 2(d)(1) of the IMPACT Act of 2014 
                          (Public Law 113-185; 42 U.S.C. 1395lll note) 
                          with respect to the application of risk 
                          adjustment under this subsection, the Secretary 
                          is required to base such risk adjustment on the 
                          reports submitted under subparagraphs (A)(ii) 
                          and (B)(ii) of such section as well as on the 
                          report submitted by the Medicare Payment 
                          Advisory Commission under section 2(c) of the 
                          Establishing Beneficiary Equity in the Hospital 
                          Readmission Program Act of 2015. 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 2017 in order 
                          to ensure that hospitals that treat the most 
                          vulnerable populations are not unfairly 
                          penalized by the program under this subsection. 
                          For fiscal years beginning more than 5 years 
                          after the date of submission of the report 
                          under section 2(d)(1)(B)(ii) of the IMPACT Act 
                          of 2014, 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 apply.''.
      (c) MedPAC Study on 30-Day Readmission Threshold.--The Medicare 
  Payment Advisory Commission shall conduct a study on the 
  appropriateness of using a threshold of 30 days for readmissions under 
  section 1886(q)(5)(E) of the Social Security Act (42 U.S.C. 
  1395ww(q)(5)(E)). The Commission shall submit to Congress a report on 
  such study in its report to Congress in June 2016.
      (d) Addressing Issue of Noncompliant Patients.--Section 
  1886(q)(4)(C) of the Social Security Act (42 U.S.C. 1395ww(q)(4)(C)), 
  as amended by subsections (b) and (c), is further amended by adding at 
  the end the following new clause:
                              ``(v) 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 2017, 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 patients.''.
      (e) Excluding Certain Clinical Conditions.--
              (1) Study.--
                      (A) In general.--The Secretary of Health and Human 
                  Services shall conduct a study, consistent with this 
                  paragraph, that assesses and makes recommendations with 
                  respect to excluding patients whose clinical conditions 
                  or diagnoses may require frequent hospitalizations, 
                  from the calculation of excess readmissions under 
                  section 1886(q)(5)(E) of the Social Security Act (42 
                  U.S.C. 1395ww(q)(5)(E)).
                      (B) 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 
                  measurement, to provide input and recommendations on 
                  the study conducted under this paragraph.
                      (C) Clinical conditions to be considered.--In 
                  conducting the study, the Secretary shall consider 
                  exclusions for patients with transplants, burns, 
                  psychosis, and substance abuse disorders. The Secretary 
                  may include additional clinical conditions where 
                  appropriate care may require frequent hospitalizations.
                      (D) Transparency.--The Secretary shall make a draft 
                  of report on such study available for public comment 
                  for a period of not less than 30 days. The final study 
                  and recommendations shall address the Secretary's 
                  response to public comments.
                      (E) Deadline.--The Secretary shall submit a final 
                  report on the study to Congress no later than Oct. 1, 
                  2016. Such final report shall include recommendations 
                  regarding the relevant clinical conditions that should 
                  be excluded from the calculation of excess readmissions 
                  described in subparagraph (A).
              (2) Application to calculation of excess readmissions.--
          Beginning with fiscal year 2018, the Secretary shall exclude 
          any relevant clinical conditions identified in the 
          recommendations made in the final report under paragraph (1)(E) 
          in determining a hospital's publicly reported readmission rate 
          and excess readmissions ratio under section 1886(q)(4)(C) of 
          the Social Security Act (42 U.S.C. 1395ww(q)(4)(C)). 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 
          used.
      (f) Budget Neutral Implementation.--The Secretary of Health and 
  Human Services shall make such payment adjustment to subsection (d) 
  hospitals under the inpatient prospective payment system under section 
  1886 of the Social Security Act (42 U.S.C. 1395ww) as may be necessary 
  to ensure that the implementation of the this section (including the 
  amendments made by this section) does not result in an increase in 
  aggregate expenditures under such section 1886.
target: Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015 This bill amends title XVIII (Medicare) of the Social Security Act (SSAct) with respect to the hospital readmissions reduction program under the inpatient (hospital) prospective payment system (IPPS). The Secretary of Health and Human Services, in determining a hospital's excess readmission ratio for purposes of making payments for discharges occurring during FY2016-FY2017, is required to make a risk adjustment to the ratio that takes into account both: (1) a hospital's proportion of inpatients who are full-benefit dual eligible individuals (eligible for both Medicare and Medicaid under SSAct title XIX), and (2) the socioeconomic status of patients served by the hospital.  The Secretary must base the risk adjustment under the readmission program for subsequent fiscal years on specified reports required by the Improving Medicare Post Acute Care Transformation Act of 2014 as well as a report the Medicare Payment Advisory Commission shall submit on the appropriateness of using a threshold of 30 days for readmissions under the program. The Administrator of the Centers for Medicare &amp; Medicaid Services must then incorporate report recommendations in carrying out risk adjustments for discharges occurring in such fiscal years in order to ensure that the most vulnerable populations are not unfairly penalized by the program.  The Secretary shall consider the use of V or other International Classification of Diseases-related codes for potential exclusion of noncompliant patient cases when promulgating related regulations for FY2017. The Secretary must: (1) assess whether to exclude from the calculation of excess readmissions any patients whose clinical conditions or diagnoses may require frequent hospitalizations; then (2) exclude, starting in FY2018, any relevant clinical conditions identified in the assessment recommendations when determining a hospital's publicly reported readmission rate and excess readmissions ratio. The Secretary is directed to make a payment adjustment to subsection (d) hospitals necessary to ensure that the implementation of this Act does not result in any increase in aggregate expenditures under the IPPS. (Generally, a subsection (d) hospital is an acute care hospital, particularly one that receives payment under the IPPS when providing covered inpatient services to eligible beneficiaries.)
feat_title: Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015