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H.R. 5273 (114th): Helping Hospitals Improve Patient Care Act of 2016

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The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Jun 7, 2016.

Helping Hospitals Improve Patient Care Act of 2016


(Sec. 101) The bill amends title XVIII (Medicare) of the Social Security Act to require the Centers for Medicare & Medicaid Services (CMS) to develop, with respect to claims for hospital services, codes under the Healthcare Common Procedure Coding System (HCPCS) for similar inpatient and outpatient hospital services.

(Sec. 102) 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.

(Sec. 103) 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.

(Sec. 104) 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.

(Sec. 105) The bill reduces the amount by which hospital payment rates for inpatient services increase in FY2018.


(Sec. 201) The bill excludes certain off-campus outpatient departments (OPDs) from specified rules that mandate lower Medicare payments. Specifically, the exclusion applies to: (1) cancer hospitals in off-campus OPDs, and (2) mid-build OPDs. A "mid-build" OPD is one for which the provider had, before a certain date, a binding written agreement with an outside party for construction.

(Sec. 203) With respect to payment reductions for failing to meet requirements for the meaningful use of electronic health records (EHRs), the bill exempts eligible professionals who are based in ambulatory surgical centers.


(Sec. 301) Until plan year 2019, CMS may not terminate an MA plan solely because the plan failed to achieve a specified minimum quality rating.

(Sec. 302) CMS must annually report on Medicare enrollment data, as specified by the bill.

(Sec. 303) CMS shall: (1) request information and recommendations from stakeholders on information included in the Welcome to Medicare package, and (2) update the information included in the package accordingly.