Provision in Patient Protection and Affordable Care Act addresses PSO participation

The following is an excerpt from the Affordable Care Act related to health insurance exchanges and hospital PSO participation:

Health insurance exchanges. Participating health plans may only contract with hospitals with greater than 50 beds when the hospital is working with a PSO. State-based health insurance exchanges are to be in place by January 1, 2014, and the compliance date for hospital contracts is January 1, 2015.

Note that the “patient safety evaluation system” referred to below is from 42USC299b-21(6): The term “patient safety evaluation system” means the collection, management, or analysis of information for reporting to or by a patient safety organization.

Section 1311. Affordable choices of health benefit plans. [Establishing state-based health insurance exchanges]

(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).