Appendix A - Section 3026 of the ACA

111TH CONGRESS
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2d Session

LEGISLATIVE COUNSEL

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PRINT 111–1

COMPILATION OF PATIENT PROTECTION
AND AFFORDABLE CARE ACT

[As Amended Through May 1, 2010]
INCLUDING

PATIENT PROTECTION AND AFFORDABLE CARE ACT
HEALTH-RELATED PORTIONS OF THE HEALTH CARE
EDUCATION RECONCILIATION ACT OF 2010

AND

PREPARED BY THE

Office of the Legislative Counsel
FOR THE USE OF THE

U.S. HOUSE OF REPRESENTATIVES

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MAY 2010

OFFICE OF THE LEGISLATIVE COUNSEL
SANDRA L. STROKOFF, Legislative Counsel
EDWARD G. GROSSMAN, Deputy Legislative Counsel

Prepared by
EDWARD G. GROSSMAN, Deputy Legislative Counsel
with the assistance of
CRAIG A. STERKX, Publications Coordinator
ELONDA C. BLOUNT, Staff Assistant
EMILY M. VOLBERDING, Staff Assistant

This document is of the Patient Protection and Affordable Care
Act (‘‘PPACA’’; Public Law 111–148) consolidating the amendments
made by title X of the Act and the Health Care and Education Reconciliation Act of 2010 (‘‘HCERA’’; Public Law 111–152). The text
of the Indian Health Care Improvement Reauthorization and Extension Act of 2009 (S. 1790), as enacted (in amended form) by section 10221 of PPACA, is shown in a separate, accompanying document.
Preparation of document.—This document was prepared by
the attorneys and staff of the House Office of the Legislative Counsel (HOLC) for the use of its attorneys and clients. It is not an official document of the House of Representatives or its committees
and may not be cited as ‘‘the law’’. At the request of the Leadership, it is being made available to the public through Congressional
websites and may be downloaded at http://docs.house.gov/
energycommerce/ppacacon.pdf. Errors in this document are solely
the responsibility of HOLC. Please email any corrections to
‘‘[email protected]’’. This document (originally dated
May 24, 2010) may be updated to reflect corrections of errors or
subsequent changes in law.
United States Code citations.—United States Code section
numbers assigned to sections in PPACA are specified in brackets
after the section numbers in the heading of each section, viz., 2711
ø42 U.S.C. 300gg–11¿.

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333

PPACA (Consolidated)

Sec. 3026

‘‘SEC. 399KK ø42 U.S.C. 280j–3¿. QUALITY IMPROVEMENT PROGRAM FOR
HOSPITALS WITH A HIGH SEVERITY ADJUSTED READMISSION RATE.
‘‘(a) ESTABLISHMENT.—
‘‘(1) IN GENERAL.—Not later than 2 years after the date of

enactment of this section, the Secretary shall make available
a program for eligible hospitals to improve their readmission
rates through the use of patient safety organizations (as defined in section 921(4)).
‘‘(2) ELIGIBLE HOSPITAL DEFINED.—In this subsection, the
term ‘eligible hospital’ means a hospital that the Secretary determines has a high rate of risk adjusted readmissions for the
conditions described in section 1886(q)(8)(A) of the Social Security Act and has not taken appropriate steps to reduce such readmissions and improve patient safety as evidenced through
historically high rates of readmissions, as determined by the
Secretary.
‘‘(3) RISK ADJUSTMENT.—The Secretary shall utilize appropriate risk adjustment measures to determine eligible hospitals.
‘‘(b) REPORT TO THE SECRETARY.—As determined appropriate
by the Secretary, eligible hospitals and patient safety organizations
working with those hospitals shall report to the Secretary on the
processes employed by the hospital to improve readmission rates
and the impact of such processes on readmission rates.’’.
SEC. 3026 ø42 U.S.C. 1395b–1 note¿. COMMUNITY-BASED CARE TRANSITIONS PROGRAM.
(a) IN GENERAL.—The Secretary shall establish a Community-

Based Care Transitions Program under which the Secretary provides funding to eligible entities that furnish improved care transition services to high-risk Medicare beneficiaries.
(b) DEFINITIONS.—In this section:
(1) ELIGIBLE ENTITY.—The term ‘‘eligible entity’’ means the
following:
(A) A subsection (d) hospital (as defined in section
1886(d)(1)(B) of the Social Security Act (42 U.S.C.
1395ww(d)(1)(B))) identified by the Secretary as having a
high readmission rate, such as under section 1886(q) of the
Social Security Act, as added by section 3025.
(B) An appropriate community-based organization that
provides care transition services under this section across
a continuum of care through arrangements with subsection
(d) hospitals (as so defined) to furnish the services described in subsection (c)(2)(B)(i) and whose governing body
includes sufficient representation of multiple health care
stakeholders (including consumers).
(2) HIGH-RISK MEDICARE BENEFICIARY.—The term ‘‘highrisk Medicare beneficiary’’ means a Medicare beneficiary who
has attained a minimum hierarchical condition category score,
as determined by the Secretary, based on a diagnosis of multiple chronic conditions or other risk factors associated with a
hospital readmission or substandard transition into post-hospitalization care, which may include 1 or more of the following:
(A) Cognitive impairment.
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Sec. 3026

PPACA (Consolidated)

334

(B) Depression.
(C) A history of multiple readmissions.
(D) Any other chronic disease or risk factor as determined by the Secretary.
(3) MEDICARE BENEFICIARY.—The term ‘‘Medicare beneficiary’’ means an individual who is entitled to benefits under
part A of title XVIII of the Social Security Act (42 U.S.C. 1395
et seq.) and enrolled under part B of such title, but not enrolled under part C of such title.
(4) PROGRAM.—The term ‘‘program’’ means the program
conducted under this section.
(5) READMISSION.—The term ‘‘readmission’’ has the meaning given such term in section 1886(q)(5)(E) of the Social Security Act, as added by section 3025.
(6) SECRETARY.—The term ‘‘Secretary’’ means the Secretary of Health and Human Services.
(c) REQUIREMENTS.—
(1) DURATION.—
(A) IN GENERAL.—The program shall be conducted for
a 5-year period, beginning January 1, 2011.
(B) EXPANSION.—The Secretary may expand the duration and the scope of the program, to the extent determined appropriate by the Secretary, if the Secretary determines (and the Chief Actuary of the Centers for Medicare
& Medicaid Services, with respect to spending under this
title, certifies) that such expansion would reduce spending
under this title without reducing quality.
(2) APPLICATION; PARTICIPATION.—
(A) IN GENERAL.—
(i) APPLICATION.—An eligible entity seeking to
participate in the program shall submit an application
to the Secretary at such time, in such manner, and
containing such information as the Secretary may require.
(ii) PARTNERSHIP.—If an eligible entity is a hospital, such hospital shall enter into a partnership with
a community-based organization to participate in the
program.
(B) INTERVENTION PROPOSAL.—Subject to subparagraph (C), an application submitted under subparagraph
(A)(i) shall include a detailed proposal for at least 1 care
transition intervention, which may include the following:
(i) Initiating care transition services for a highrisk Medicare beneficiary not later than 24 hours prior
to the discharge of the beneficiary from the eligible entity.
(ii) Arranging timely post-discharge follow-up
services to the high-risk Medicare beneficiary to provide the beneficiary (and, as appropriate, the primary
caregiver of the beneficiary) with information regarding responding to symptoms that may indicate additional health problems or a deteriorating condition.
(iii) Providing the high-risk Medicare beneficiary
(and, as appropriate, the primary caregiver of the benJune 9, 2010

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335

PPACA (Consolidated)

Sec. 3027

eficiary) with assistance to ensure productive and
timely interactions between patients and post-acute
and outpatient providers.
(iv) Assessing and actively engaging with a highrisk Medicare beneficiary (and, as appropriate, the primary caregiver of the beneficiary) through the provision of self-management support and relevant information that is specific to the beneficiary’s condition.
(v) Conducting comprehensive medication review
and management (including, if appropriate, counseling
and self-management support).
(C) LIMITATION.—A care transition intervention proposed under subparagraph (B) may not include payment
for services required under the discharge planning process
described in section 1861(ee) of the Social Security Act (42
U.S.C. 1395x(ee)).
(3) SELECTION.—In selecting eligible entities to participate
in the program, the Secretary shall give priority to eligible entities that—
(A) participate in a program administered by the Administration on Aging to provide concurrent care transitions interventions with multiple hospitals and practitioners; or
(B) provide services to medically underserved populations, small communities, and rural areas.
(d) IMPLEMENTATION.—Notwithstanding any other provision of
law, the Secretary may implement the provisions of this section by
program instruction or otherwise.
(e) WAIVER AUTHORITY.—The Secretary may waive such requirements of titles XI and XVIII of the Social Security Act as may
be necessary to carry out the program.
(f) FUNDING.—For purposes of carrying out this section, the
Secretary of Health and Human Services shall provide for the
transfer, from the Federal Hospital Insurance Trust Fund under
section 1817 of the Social Security Act (42 U.S.C. 1395i) and the
Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in such proportion as the
Secretary determines appropriate, of $500,000,000, to the Centers
for Medicare & Medicaid Services Program Management Account
for the period of fiscal years 2011 through 2015. Amounts transferred under the preceding sentence shall remain available until
expended.
SEC. 3027. EXTENSION OF GAINSHARING DEMONSTRATION.
(a) IN GENERAL.—Subsection (d)(3) of section 5007 of

the Deficit Reduction Act of 2005 (Public Law 109–171) is amended by inserting ‘‘(or September 30, 2011, in the case of a demonstration
project in operation as of October 1, 2008)’’ after ‘‘December 31,
2009’’.
(b) FUNDING.—
(1) IN GENERAL.—Subsection (f)(1) of such section is
amended by inserting ‘‘and for fiscal year 2010, $1,600,000,’’
after ‘‘$6,000,000,’’.
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