To encourage efforts to reduce readmissions, Congress created the Hospital Readmissions Reduction Program as part of the Affordable Care Act in 2010. Of the three penalty programs created by the ACA, the HRRP is the most significant for fiscal year 2015 inpatient payments. Through the ACA, the Centers for Medicare & Medicaid Services is instructed to penalize hospitals with higher than expected readmissions for specific clinical conditions such as AMI, pneumonia and heart failure. In FFY 2015, chronic obstructive pulmonary disease and hip and knee replacements were added to the list of clinical conditions. The HRRP payment penalties took effect in FFY 2013, and hospitals can now incur a penalty of up to 3 percent of their base operating Medicare diagnosis-related group payments — the maximum penalty defined by the ACA.