House and Senate lawmakers on Tuesday double-teamed Congress with companion bills aimed at mitigating hospital readmission penalties — a positive move for nursing homes because it would ease the invariable scrutiny that surrounds readmitted low-income and dual-eligible patients.
The Hospital Readmission Reduction Program was created under the Affordable Care Act and its signature push toward accountable care and lowering hospital readmissions. Hospitals are penalized based on their three-year readmission rates. Critics of the provision claim it unfairly punishes hospitals that treat very poor and underserved groups of patients.
The House legislation would require Health and Human Services to adjust readmission penalties based on a hospital’s share of dual eligible patients, low-income seniors, or young people with a disability that are eligible for both Medicare and Medicaid. U.S. Reps. Jim Renacci (R-OH) and Eliot Engel (D-NY) introduced H.R. 1343, “Establishing Beneficiary Equity in the Hospital Readmission Program Act,” in the House, while Sens. Rob Portman (R-OH) and Joe Manchin (D-WV) introduced companion legislation in the Senate.
The House bill also would force CMS to exclude certain categories of patients with clinically valid readmissions and other mitigating circumstances.