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
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
(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).