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ACA PSO mandate

The Affordable Care Act of 2010 calls for states to create health insurance exchanges, which must be operational by Jan. 1, 2014. Health insurance exchanges are charged with expanding coverage for the uninsured, improving health care quality, reducing costs, and empowering consumers to choose a health plan that gives them the best value.

By January 1, 2017, qualified health plans in insurance exchanges may not contract with a hospital of 50 beds or more unless that hospital has a patient safety evaluation system and reports data to a PSO. The deadline originally was 2015, but has been extended two years to allow hospitals time to choose a PSO and begin reporting.

Although January 1, 2017 may seem a way off, it is not. Contracts with health plans are typically for terms of one year or more. This means that by January 1, 2016, new contracts must comply with 2017 requirements, or face cancellation at year end.

Members can call CHPSO at (916) 552-2600 to obtain support for implementing a patient safety evaluation system and automating data reporting.

Relevant text of the Affordable Care Act

Section 1311 

(h) QUALITY IMPROVEMENT.—

(1) ENHANCING PATIENT SAFETY.—Beginning on January 1, 2015, a qualified health plan may contract with—

(A) a hospital with greater than 50 beds only if such hospital—

(i) utilizes a patient safety evaluation system as described in part C of title IX of the Public Health Service Act; and

(ii) implements a mechanism to ensure that each patient receives a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional; or

(B) a health care provider only if such provider implements such mechanisms to improve health care quality as the Secretary may by regulation require.

(2) EXCEPTIONS.—The Secretary may establish reasonable exceptions to the requirements described in paragraph (1).

(3) ADJUSTMENT.—The Secretary may by regulation adjust the number of beds described in paragraph (1)(A).

Relevant text of part C of title IX of the Public Health Service Act

Patient safety evaluation system means the collection, management, or analysis of information for reporting to or by a PSO.

Commands