in the State for a participating hospital or hospitals achieves or surpasses

In the state for a participating hospital or

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Unformatted text preview: in the State for a participating hospital or hospitals achieves or surpasses the measured results in terms of patient health outcomes and cost savings established herein with respect to this section. ‘‘(3) ADJUSTMENT FACTOR.— ‘‘(A) IN GENERAL.—For purposes of paragraph (1), the adjustment factor under this paragraph for an applicable hospital for a fiscal year is equal to the greater of— ‘‘(i) the ratio described in subparagraph (B) for the hospital for the applicable period (as defined in paragraph (5)(D)) for such fiscal year; or ‘‘(ii) the floor adjustment factor specified in subparagraph (C). ‘‘(B) RATIO.—The ratio described in this subparagraph for a hospital for an applicable period is equal to 1 minus the ratio of— ‘‘(i) the aggregate payments for excess readmis-sions (as defined in paragraph (4)(A)) with respect to an applicable hospital for the applicable period; and VerDate Nov 24 2008 18:12 Apr 23, 2010 Jkt 000000 PO 00000 Frm 00312 Fmt 6655 Sfmt 6501 C:\TEMP\PPACA-CONSOLIDATED_003.XML HOLCPC April 23, 2010 (6:12 p.m.) F:\P11\NHI\COMP\PPACA-CONSOLIDATED_003.XML f:\VHLC\042310\042310.200.xml (466008|3) Ppaca & Hcera; Public Laws 111-148 & 111-152: Consolidated Print—313 ‘‘(ii) the aggregate payments for all discharges (as defined in paragraph (4)(B)) with respect to such applicable hospital for such applicable period. ‘‘(C) FLOOR ADJUSTMENT FACTOR.—For purposes of subparagraph (A), the floor adjustment factor specified in this subparagraph for— ‘‘(i) fiscal year 2013 is 0.99; ‘‘(ii) fiscal year 2014 is 0.98; or ‘‘(iii) fiscal year 2015 and subsequent fiscal years is 0.97. ‘‘(4) AGGREGATE PAYMENTS, EXCESS READMISSION RATIO DEFINED.—For purposes of this subsection: ‘‘(A) AGGREGATE PAYMENTS FOR EXCESS READMIS-SIONS.—The term ‘aggregate payments for excess readmis-sions’ means, for a hospital for an applicable period, the sum, for applicable conditions (as defined in paragraph (5)(A)), of the product, for each applicable condition, of— ‘‘(i) the base operating DRG payment amount for such hospital for such applicable period for such condi-tion; ‘‘(ii) the number of admissions for such condition for such hospital for such applicable period; and ‘‘(iii) the excess readmissions ratio (as defined in subparagraph (C)) for such hospital for such applicable period minus 1. ‘‘(B) AGGREGATE PAYMENTS FOR ALL DISCHARGES.—The term ‘aggregate payments for all discharges’ means, for a hospital for an applicable period, the sum of the base operating DRG payment amounts for all discharges for all conditions from such hospital for such applicable period. ‘‘(C) EXCESS READMISSION RATIO.— ‘‘(i) IN GENERAL.—Subject to clause (ii), the term ‘excess readmissions ratio’ means, with respect to an applicable condition for a hospital for an applicable period, the ratio (but not less than 1.0) of— ‘‘(I) the risk adjusted readmissions based on actual readmissions, as determined consistent with a readmission measure methodology that has been...
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