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On the Hill: Bill with SES Risk Adjustment Advances

On May 24, a key House committee unanimously passed legislation that would bring socioeconomic status (SES) risk adjustment to Medicare’s Hospital Readmissions Reduction Program (HRRP), and also provide some relief from a 2015 law that reduces hospital outpatient department (HOPD) payments.

The House Committee on Ways and Means approved H.R. 5273, the Helping Hospitals Improve Patient Care Act. The bill would strengthen essential hospitals’ capacity to continue serving their communities by leveling the playing field in the HRRP through SES risk adjustment. It also would allow hospitals that were in the process of constructing off-campus HOPDs last year to continue billing Medicare at the HOPD rate, rather than at a reduced rate as required by the Bipartisan Budget Act (BBA) of 2015.

America’s Essential Hospitals has long advocated SES risk adjustment. The provision in H.R. 5273 mirrors H.R. 1343, the Establishing Beneficiary Equity in the Hospital Readmission Program Act, sponsored by Reps. Jim Renacci (R-OH) and Eliot Engel (D-NY). America’s Essential Hospitals worked directly with Renacci and Engel to craft language that would prevent unfair penalization of hospitals caring for the most vulnerable. The association issued a statement supporting H.R. 5273 and its inclusion of the H.R. 1343-based provision. Also, in a letter this week, the association thanked lawmakers for their work.

While America’s Essential Hospitals supports grandfathering “mid-build” off-campus HOPDs, as stipulated in H.R. 5273, it  remains concerned the BBA-mandated payment cuts still will erode the ability of essential hospitals to expand care in low-income and underserved communities. The association continues to call for an exemption for HOPDs in underserved areas or that disproportionately treat vulnerable patients.

Also in committee business, the House Committee on Energy and Commerce held a hearing May 24 focused on Medicaid and Medicare program integrity. The committee also announced it will mark up mental health legislation in June.

On the House and Senate floors, health care action is slow, as both chambers prepare for district and state work periods next week.

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About the Author

Jocelyn Wiles is the manager of legislative affairs at America's Essential Hospitals.

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