Bills
| 3.23.22

Reforming Medicare to Help Hospitals and Improve Enrollment Data (H.R. 5273)

Do you support or oppose this bill?

What is H.R. 5273?

(Updated March 6, 2018)

This bill would implement a number of reforms to Medicare’s payment system aimed at helping hospitals better serve their patients, particularly in low-income communities, in addition to updating how Medicare enrollment data is reported.

The Dept. of Health and Human Services (HHS) would be required to change the Hospital Readmissions Reduction Program to ensure that hospitals serving low-income patients aren’t penalized by being compared to hospitals with a dissimilar patientbase. Currently the calculation doesn’t account for disparities in the frequency of hospital visits by different socioeconomic groups, which punishes hospitals serving lower-income patients.

Hospital outpatient departments (HOPD) classified as “mid-build” would be required to certify that they’re provider-based to HHS, which would be responsible for auditing those claims to receive the full HOPD payment rate rather than a lower fee schedule. Essentially, this lets hospitals that were building HOPDs when a November 2015 change occurred to bill Medicare, even though current law would have otherwise prevented them from doing so.

HHS’ ability to terminate Medicare Advantage (MA) contracts based on a failure to achieve minimum quality ratings under the MA STARS rating system would be delayed for three years. The Centers for Medicare and Medicaid Services (CMS) could still terminate plans for the 10 other performance categories included in a Past Cycle Performance Review.

HHS would be required to publish Medicare enrollment data by Congressional District, zip code, and state each year. This would include MA, Part D, plus fee-for-service enrollment data, and comprehensive enrollment report for Medicare no later than June 1 of each calendar year with the preceding year’s data.

Argument in favor

This bipartisan legislation contains a number of straightforward fixes to Medicare that will help hospitals better serve their patients and lead to improved data reporting about Medicare enrollment.

Argument opposed

Congress shouldn’t need to fix changes to Medicare that it made less than one year ago, and HHS should be able to terminate providers’ Medicare Advantage contracts for failing to meet any minimum standard.

Impact

Medicare enrollees; healthcare providers — particularly hospital outpatient departments and long-term care facilities; and HHS.

Cost of H.R. 5273

The CBO estimates that implementing this bill would increase spending by $50 million over the 2017-2021 period while decreasing spending by $14 million over the 2017-2026 period.

Additional Info

In-Depth: Sponsoring Rep. Pat Tiberi (R-OH) introduced this bill to provide needed reforms for hospitals and other Medicare providers so as to support the development of outpatient facilities and allow hospitals to treat more low-income patients:

“The Helping Hospitals Improve Patient Care Act takes responsible steps to strengthen Medicare and give hospitals and health care providers the certainty they need to best serve their patients. It is fully paid for and includes many bipartisan provisions that are priorities to members of the Ways and Means Committee.”

The House Ways and Means Committee passed this legislation by voice vote.



Media:

Summary by Eric Revell
(Photo Credit: Flickr user VCU Libraries)