[G^Tibi-ary 1 C2-Q7-i3 I 7B^?t0fi0mfStejc-us.:-!MtayrDyltvedn.ci 21244 |i. -li congress IIOtii S.3116 2d Session To amend title XAnil of the Soeial Seeui-ity Act to stabilize and iiiodei-nize the pimision of ])artial hos))itaHzati()ii sei'viccs uiidcr the ^h'dicai'c \m)- gram, and for other jmrposes. IN THE SENATE OF THE UNITED STATES June 11, 2008 Ml". VlTTEK intr()(hi('ed the following' l)i!l; wliieh was read twiee and refei-ivd to the Committee on P^inanee A BILL To amend title X\n[n of the Social Security Act to stabilize and modernize the provision of partial hospitalization semces under the Medicare program, and for other pur- poses. 1 Be it enacted hy the Senate and House ofRepresenta- 2 tives ofthe United States ofAmerica in Congress assembled, 3 SECTION 1. SHORT TITLE. 4 This Act may be cited as the "Outpatient Mental 5 HealthModernization Actof 2008". — 1 SEC. 2. TRANSITIONAL FREEZE ON CERTAIN MEDICARE 2 HOSPITAL OUTPATIENT FEE SCHEDULE 3 AMOUNTS. 4 NotA\itlistaiidiiio- any other proAisioii of law, effective 5 for episodes and Aisits beginning- on or after Januaiy 1, 6 2009, and before January 1, 2010, in the ease of partial 7 hospital seniees (as defined in section 1861(ff)(l) of the OPD 8 Social Security Act (42 U.S.C. 1395x(fT)(l)), the fee 9 schedule increase factor under section 1833(t)(3)(C)(iv) of 10 the Social Security Act (42 U.S.C. 13951(t)(3)(C)(iv)) for 11 the medicare OPD fee schedule amount established for 12 such sendees (as published in the Federal Register on No- 13 vember 27, 2007 (72 Fed. Reg. 66670)) shall be zero. 14 SEC. 3. ACCREDITATION PROGRAM FOR COMMUNITY MEN- 15 TAL HEALTH CENTERS PROVIDING PARTIAL 16 HOSPITALIZATION SERVICES. 17 Section 1833(t) of the Social Security Act (42 U.S.C. 18 13951(t)) is amended by adding at the end the folkming 19 new paragraph: 20 "(18) AccUiEDITATION PK()(iKAM FOR COIMMU- 21 NITY MENTAL HEALTH CENTERS PR()\lDIN(i PAR- 22 TLVL HOSPITALIZATION SER\1CES. — 23 "(A) Definitions. In this section: 24 "(i) Accreditation oRGiVNizA- — 25 TION. The term 'accreditation organiza- 26 tion' means an organization designated b}^ •S 3116 IS 3 1 the Secretary under siibparagTaph 2 ((')(i)(TI) to accredit ('oniiiiiinity mental 3 health centers pro\dding' partial hospitaliza- 4 tion sendees. 5 "(ii) Partial hospitalization — 6 SEHVK^ES. The term '])artial li()S])italiza- 7 tion sei'vices' has the meaning- given such 8 term in section 1861(ff)(l). — 9 "(iii) Physician. Except as other- 10 wine i)ro^dded by the Secretary, the term 11 'physician' means any individual who fur- 12 nishes semces for which payment may be 13 made under the ])hysician fee schedule 14 under section 1848. 15 "(iv) PlIYSK'LVN SPECIALTY OKGANI- — 16 ZATION. The term 'physician s])ecialty or- 17 ganization' means a United States medical 18 specialty society that represents diplomats 19 certified by a board recognized by the 20 American Board of Medical SixH'ialties. . — 21 "(B) Establishment. Not later than 22 January 1, 2010, subject to the succeeding pro- 23 visions of this paragrai^h, the Secretary shall, 24 by regulation, establish an accreditation pro- 25 gram which requires the accreditation of com- S 3116 IS — 4 1 - munity mental health centers pro\iding' partial 2 hospitalization sei'\aces. 3 "(C) Design of accreditation pro- — 4 GUAM. — 5 "(i) In general. Each community 6 mental health center l)ro^^(ling• i)artial hos- 7 pitalization sendees for which ])a}inent is 8 made undei' the i)rospective pa;\anent sys- 9 tern established under this subsection must 10 be accredited for each progi^am under 11 which such sendees are furnished by the 12 connnunity mental health centei* by an ac- 13 crediting- org-anization desionated by the 14 Secretary under clause (ii). 15 "(ii) Accreditation oRGiVNizA- 16 TIONS. 17 "(I) In general.—The Sec- 18 retary shall, by regulation, desig^iate 19 entities to accredit connnunity mental 20 health centers pro^dding' ])artial hos- 21 pitalization ser^dces. The entities des- 22 ignated nndei- the preceding sentence 23 shall include the Joint (\)imnission on 24 Accreditation of Hospitals and the S 3116 IS 5 1 Commission on Accreditation of Keha- 2 bilitation Facilities. — 3 "(II) CoNSUi/rATiON. 111 (lesig;- 4 nating' entities under snlx'lanse (I), 5 the Secretary shall consult \\ith aca- 6 demic medical centers, connnunity 7 mental health centers, hosj^itals, and 8 other appi'opriate medical personnel 9 (such as psychologists, social workers, 10 and nurse specialists). — 11 "(iii) Considerations. In desig- 12 nating entities under clause (ii), the Sec- 13 retary shall consider the follcming: 14 "(I) The ability of the entity to 15 conduct timely ]'e^^ews of accredita- 16 tion applications. 17 "(II) Wliether the entity has es- 18 tablished a process for the timely inte- 19 gration of new sendees and clinical 20 interventions for indi^lduals who are 21 fimiished partial hospitalization sew- 22 ices. 23 "(III) Any other factors the Sec- ' 24 retary determines a})pr()pi'iate. S 3116 IS — 6 1 "(iv) Use op criteria for accredi- - — 2 TATION. ^Accreditation organizations shall 3 use appropriate criteria for evaluating 4 comnnmity mental health centers providing 5 partial hospitalization sei^vices for purposes 6 of the accreditation of such community 7 mental health centers, including criteria 8 with respect to 9 "(I) the qualifications of non- 10 physician medical jjersonnel; 11 "(11) the qualifications and re- 12 sponsibilities of physicians, including 13 su]Dendsing ])hysicians; 14 "(III) the establishment of proce- 15 dures for ensuring i:)atient safety; and 16 "(r\^) quality assurance report- 17 ing. 18 "(v) Incorporation op quai^ity — 19 MEASURES. Not later tlian January 1, 20 2012, the Secretary shall ])ro\ide for the 21 - incorporation of measures selected for pur- 22 poses of (luality reporting under ])aragraph 23 (19) into the accreditation ]3rogram estab- 24 lished under this paragraph, inchiding the •S 3116 IS — — 7 1 use of such measures in the ei-iteiia for ae- 2 - creditation uuder clause (iv). 3 "(vi) RE\aEW OF accreditation or- - — 4 GANIZATI0N8. The Secretaiy, iu cousulta- 5 tion mth the entities and indi\dduals de- 6 scribed in clause (ii)(II) 7 "(I) shall conduct an annual re- 8 View of accreditation organizations 9 designated under clause (ii); and 10 "(II) may, by regiilation, exi^and 11 the original list of accreditation orga- 12 nizations so designated. 13 "(D) EViVIjUATION AND REPORT. — 14 "(i) Evaluation. The Secretaiy 15 shall contract mth an indei)endent, private 16 organization or entity to evaluate the effect 17 of the accreditation program established 18 under this paragTaph and other relevant 19 questions invohdng access to and value of 20 partial hosi^italization sendees furnished to 21 individuals under this part. Such evalua- 22 tion shall examine the folkwing: 23 "(I) The impact of accreditation 24 - requirements on the number, t^^)e, 25 and quality of partial hospitalization •S 3116 IS 8 1 - sendees furnished to iiidmduals under 2 this part. 3 "(11) The cost of meeting; such 4 accreditation requirements, inchiding 5 an examination of comphance costs to 6 community mental heahh centers pro- 7 Adding' partial hospitalization services 8 and administrative costs to the Sec- 9 retary. 10 "(III) The access of individuals 11 under this part to partial hospitaliza- 12 tion sendees, especially in rural areas, 13 hefore and after implementation of 14 the accreditation ])rog,Tam. 15 "(r\0 Any other matters the Sec- 16 retary determines appropriate. 17 "(ii) Report.—Not later than De- 18 cember 31, 2012, the Secretary shall sub- 19 mit a report to CV)ng'ress on the evaluation 20 conducted under clause (i). — 21 "(E) Warh^r authority. The Secretary 22 shall waive com]iliance \\dth the r(H|uirements of 23 this title to such extent and foi- such ])eriod as 24 the Secretary determines is necessary to cany 25 out this paragi'aph.". •S 3116 IS — 9 SEC. QUALITY IMPROVEMENT FOR PARTIAL HOS- 1 4. 2 PITALIZATION SERVICES PROVIDED BY COM- 3 MUNITY MENTAL HEALTH CENTERS. 4 Section 1833(1) of the Social Security Act (42 U.S.C. 5 13951(t)), as amended by section 3, is amended by adding- 6 at the end the following' new paragraph: 7 "(19) Quality reporting for partial iios- 8 pitalization servkli]s provided by cu)mmunity 9 mental health centers. 10 "(A) Reduction in update for failure — 11 TO report. For i)urposes of ])aragra])h 12 (3)(C)(iv) for 2009 and each subsequent .year, 13 in the case of a connnunity mental health cen- 14 ter i^rcmding partial hospitalization sendees (as 15 defined in section 1861(ff)(l)) that does not 16 submit, to the Secretary in accordance with this 17 l)arag*raph, data reciuired to be submitted on 18 measures selected under this paragTa])h with re- OPD 19 spect to such a calendar year, the fee 20 schedule increase factor under paragraph 21 (3)(C)(iv) for such year shall be reduced by 1.0 A 22 percentage point. reduction under the i)re- 23 ceding sentence shall ai)ply only with respect to " 24 the year involved and the Secretary shall not 25 take into account such reduction in comimting •S 3116 IS — 10 OPD 1 • the fee schedule increase factor for a sub- 2 sequent calendar year. 3 "(B) Form and i\/[anner of submis- 4 SION. — 5 "(i) In general. Subject to clause 6 (ii), each connnunity mental health center 7 i:)ro\idino- i^artial lK)S])italization sei'vices 8 shall submit to the Secretary data on 9 measures selected under this paragTaj^h in 10 a form and manner, and at a time, speci- 11 fied by the Secretary for purposes of this 12 i)aragTaph. 13 "(ii) Gra("e PERioi:) for sth^mission — 14 IN 2011. In the case of such data sub- 15 mitted v^ith respect to 2011, the Secretary 16 shall ])rovide foi* a 30-day grace period for 17 the submission of such data l)y a commu- 18 nity mental health center i)roAiding partial 19 hospitalization senices. — 20 "(C) Development of measurer. — 21 • "(i) In (JENERAL. The Secretary 22 shall select measures that the Secretary 23 determines a])])r()])riate for the measure- 24 ment of the (|uality of care ])ro^^(led by 25 community mental health centers })r(m(ling' •S 3116 IS