HR-5273 : Still Just a Bill

Helping Hospitals Improve Patient Care Act of 2016

The bill amends title XVIII (Medicare) of the Social Security Act to alter provisions related to hospital services, medical services, and Medicare Advantage (MA).

With respect to claims for hospital services, the Centers for Medicare & Medicaid Services (CMS) shall develop codes under the Healthcare Common Procedure Coding System (HCPCS) for similar inpatient and outpatient hospital services.

The bill establishes processes for adjusting a hospital's Medicare payments based on the hospital's overall proportion of inpatients who are dually eligible for Medicare and Medicaid.

The bill extends for five years the Rural Community Hospital Demonstration Program, through which Medicare pays certain rural hospitals on the basis of reasonable incurred costs rather than under the standard prospective payment system.

With respect to long-term care hospitals, the bill lifts a moratorium on bed increases. The bill reduces rates for high-cost outlier payments, which are additional Medicare payments made in extraordinarily high-cost cases.

The bill reduces the amount by which hospital payment rates for inpatient services increase in FY2018.

The bill excludes certain off-campus outpatient departments from specified rules that mandate lower Medicare payments. 

With respect to payment reductions for failing to meet requirements for the meaningful use of electronic health records (EHR), the bill exempts eligible professionals who are based in ambulatory surgical centers.

Until plan year 2019, CMS may not terminate an MA plan solely because the plan failed to achieve a specified minimum quality rating.