[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2988 Introduced in Senate (IS)]
108th CONGRESS
2d Session
S. 2988
To amend title XVIII of the Social Security Act to provide medicare
beneficiaries with access to information concerning the quality of care
provided by skilled nursing facilities and to provide incentives to
skilled nursing facilities to improve the quality of care provided by
those facilities by linking the amount of payment under the medicare
program to quality reporting and performance requirements, and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 17, 2004
Mr. Wyden introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide medicare
beneficiaries with access to information concerning the quality of care
provided by skilled nursing facilities and to provide incentives to
skilled nursing facilities to improve the quality of care provided by
those facilities by linking the amount of payment under the medicare
program to quality reporting and performance requirements, and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Long Term Care Quality and Consumer
Information Improvement Act of 2004''.
SEC. 2. MEDICARE PAYMENT ADJUSTMENTS FOR SKILLED NURSING FACILITIES
BASED ON QUALITY DATA.
(a) In General.--Section 1888(e) of the Social Security Act (42
U.S.C. 1395yy(e)) is amended by adding at the end the following new
paragraph:
``(13) Payment adjustments based on quality data.--
``(A) Establishment of quality measures.--
``(i) In general.--Subject to the
succeeding provisions of this subparagraph, not
later than July 1, 2005, the Secretary shall
establish between 10 and 15 quality measures
applicable with respect to skilled nursing
facilities in addition to any quality measures
applicable with respect to such facilities
established prior to January 1, 2005.
``(ii) Consultation.--In establishing the
quality measures under clause (i), the
Secretary shall consult with--
``(I) residents of skilled nursing
facilities;
``(II) representatives of patient
advocacy organizations;
``(III) State regulatory
representatives;
``(IV) representatives from the
skilled nursing facility industry; and
``(V) experts on quality measures.
``(iii) Staffing and mix of licensed
staff.--At least one of the quality measures
established under clause (i) shall relate to
the level of skilled nursing facility staffing
and the mix of licensed staff.
``(iv) Establishment and application of
risk adjustment methodology.--The quality
measures established under clause (i) shall
take into account the relative risks associated
with the population of each skilled nursing
facility to ensure that the differences in the
quality measures reflect differences in the
care provided by the facilities and not
differences in resident population
characteristics by using a risk adjustment
methodology established for purposes of this
subsection. The risk adjustment methodology
established and applied under this clause may
exclude certain types of residents, stratify
residents into high-risk and low-risk groups,
or use a statistical adjustment, such as a
regression analysis, that takes into
consideration multiple characteristics for each
resident.
``(v) Special provision for small skilled
nursing facilities.--The Secretary, in
consultation with the individuals and groups
described in clause (ii), shall establish
criteria for determining which quality measures
established under clause (i) do not apply with
respect to skilled nursing facilities that are
not large enough to yield meaningful data with
respect to such measure.
``(vi) Annual review and revision.--The
Secretary, in consultation with the individuals
and groups described in clause (ii), shall
annually review and revise the quality measures
established under clause (i), as the Secretary,
in consultation with such individuals and
groups, determines appropriate.
``(B) Reporting on quality measures.--
``(i) Submission of data.--Each skilled
nursing facility that desires to receive a
payment adjustment under subparagraph (C) shall
submit such data at such time and in such form
and manner as the Secretary, in consultation
with the individuals and groups described in
subparagraph (A)(ii), requires for purposes of
applying the quality measures established under
subparagraph (A)(i).
``(ii) Publication of quality ratings.--Not
less frequently than annually, the Secretary
shall cause to be posted on the Internet
website of the Centers for Medicare & Medicaid
Services and to be published in newspapers with
a national circulation a quality rating for
each skilled nursing facility submitting data
under clause (i) by using such data to apply
the quality measures established under
subparagraph (A)(i) to each facility.
``(C) Additional payment amount.--
``(i) In general.--Subject to clause (iv),
each skilled nursing facility that submits data
under subparagraph (B)(i) shall receive the
update described in clause (ii) and the payment
adjustment described in clause (iii).
``(ii) Full market basket update.--
Notwithstanding paragraph (4)(E)(ii) or any
other provision of law, each skilled nursing
facility described in clause (i) shall receive
the full market basket update for the year
following the year in which such data is
submitted.
``(iii) Payments based on quality.--The
Secretary shall adjust the total payment amount
under this subsection for skilled nursing
facilities described in clause (i) as follows:
``(I) Beginning with fiscal year
2006, for each of the skilled nursing
facilities that the Secretary
determines, based on the quality
measures established under subparagraph
(A)(i) for the preceding fiscal year,
to be--
``(aa) in the top 10
percent of all nursing
facilities that submitted data
under subparagraph (B)(i)
during the preceding fiscal
year, each payment amount
determined under the other
provisions of this subsection
shall be increased by 2 percent
of that amount; and
``(bb) below the top 10
percent of such nursing
facilities, but within the top
20 percent of such facilities,
each payment amount determined
under the other provisions of
this subsection shall be
increased by 1 percent of that
amount.
``(II) Beginning with fiscal year
2007, for each of the skilled nursing
facilities that the Secretary
determines, based on the quality
measures established under subparagraph
(A)(i), to be in the bottom 20 percent
of all nursing facilities that
submitted data under subparagraph
(B)(i), each payment amount determined
under the other provisions of this
subsection shall be decreased by 1
percent of that amount.
``(iv) Special provision for small skilled
nursing facilities.--The Secretary may not
refuse to provide a full market basket update
under clause (ii) or to provide an increase or
reduction under clause (iii) with respect to a
skilled nursing facility because such facility
does not submit data with respect to a quality
measure that does not apply to the nursing
facility as a result of the application of the
criteria established under subparagraph (A)(v).
``(D) Budget neutrality.--In implementing this
paragraph, the Secretary shall ensure that the
aggregate amount of expenditures made by the Secretary
under this title in a fiscal year does not exceed the
aggregate amount which the Secretary would have
expended under this title in the year if this paragraph
had not been enacted. In determining the aggregate
amount which the Secretary would have expended under
this title in the year if this paragraph had not been
enacted, the Secretary shall assume a current services
budget baseline that includes in the assumption of
current services a level of expenditures for covered
skilled nursing facility services that reflects a
continuation of the Resource Utilization Groups (RUGS)
that were used for making payments under this section
during fiscal year 2004.''.
(b) Evaluation and Report.--
(1) Evaluation.--The Secretary of Health and Human Services
shall conduct an evaluation of the implementation of the
amendment made by subsection (a), including an evaluation of
the number of skilled nursing facilities that submit the data
pursuant to paragraph (13)(B) of section 1888(e) of the Social
Security Act (42 U.S.C. 1395yy(e)), as added by subsection (a).
(2) Report.--Not later than December 31, 2007, the
Secretary of Health and Human Services shall submit a report to
Congress on the evaluation conducted under paragraph (1)
together with recommendations for such legislation and
administrative actions as the Secretary considers appropriate.
<all>