Home Health Access Preservation Act of 1998

Summary: Home Health Access Preservation Act of 1998 - Amends title XVIII (Medicare) of the Social Security Act (SSA), as amended by the Balanced Budget Act of 1997, with respect to the computation formula of the interim system of limited payments for services provided by home health agencies, in order to mandate a new interim system, as of October 1, 1998, with a revised formula and specific amounts for the agency-specific per beneficiary annual limitation, according to the census division in which an agency is located. 
Directs the Secretary of Health and Human Services to:  (1) estimate the amount of savings (if any) to Medicare resulting from this Act for each fiscal year beginning after FY 1998 and before the first fiscal year in which the prospective payment system (PPS) for home health agencies applies; (2) prescribe rules for increased payments to such an agency, if there will be estimated savings; and (3) establish procedures to provide heightened scrutiny of claims for reimbursement under Medicare for items and services provided to certain agency beneficiaries. 
Amends SSA title XVIII to provide for a three percent increase in per visit cost limits for cost reporting periods beginning on or after October 1, 1997. 
Directs the Secretary to meet every 90 days with appropriate congressional committee staff to provide informal updates of progress in implementing the PPS above.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Home Health Access Preservation Act 
of 1998''.

SEC. 2. REVISION OF PER BENEFICIARY LIMIT.

    (a) In General.--
            (1) In general.--Section 1861(v)(1)(L) of the Social 
        Security Act (42 U.S.C. 1395x(v)(1)(L)) (as amended by section 
        4602(c) of the Balanced Budget Act of 1997) is amended--
                    (A) by amending clause (v) to read as follows:
    ``(v) For services furnished by home health agencies for cost 
reporting periods beginning on or after October 1, 1998, the Secretary 
shall provide for an interim system of limits. Payment shall not exceed 
the costs determined under the preceding provisions of this 
subparagraph or, if lower, the product of--
            ``(I) the agency-specific per beneficiary annual limitation 
        (as determined under clause (viii)) (which is calculated based 
        50 percent on the national average of all payments under this 
        title for home health services per person served during 
        calendar year 1994 and 50 percent on the average of all 
        payments under this title for home health services per person 
        served in the agency's census division in calendar year 1994); 
        and
            ``(II) the agency's unduplicated census count of patients 
        (entitled to benefits under this title) for the cost reporting 
        period subject to the limitation.''; and
                    (B) by adding at the end the following:
    ``(viii) For purposes of clause (v)(I), the agency-specific per 
beneficiary annual limitation is the following amount (adjusted by the 
area wage index applicable under section 1886(d)(3)(E) and determined 
in the manner described in clause (iii)):
            ``(I) For an agency located in the New England census 
        division (Connecticut, Maine, Massachusetts, New Hampshire, 
        Rhode Island, and Vermont), $4,019.50.
            ``(II) For an agency located in the Middle Atlantic census 
        division (New Jersey, New York, and Pennsylvania), $3,523.50.
            ``(III) For an agency located in the East North Central 
        census division (Illinois, Indiana, Michigan, Ohio, and 
        Wisconsin), $3,644.00.
            ``(IV) For an agency located in the West North Central 
        census division (Iowa, Kansas, Minnesota, Montana, Nebraska, 
        North Dakota, and South Dakota), $3,443.50.
            ``(V) For an agency located in the South Atlantic census 
        division (Delaware, the District of Columbia, Florida, Georgia, 
        Maryland, North Carolina, South Carolina, Virginia, and West 
        Virginia), $4,041.00.
            ``(VI) For an agency located in the East South Central 
        census division (Alabama, Kentucky, Mississippi, and 
        Tennessee), $4,672.50.
            ``(VII) For an agency located in the West South Central 
        census division (Arkansas, Louisiana, Oklahoma, and Texas), 
        $4,946.50.
            ``(VIII) For an agency located in the Mountain census 
        division (Arizona, Colorado, Idaho, Montana, Nevada, New 
        Mexico, Utah, and Wyoming), $4,033.00.
            ``(IX) For an agency located in the Pacific census division 
        (Alaska, California, Hawaii, Oregon, and Washington), 
        $3,939.00.''.
            (2) Conforming amendments.--Section 1861(v)(1)(L)(vi) of 
        the Social Security Act (42 U.S.C. 1395x(v)(1)(L)(vi)) (as 
        added by section 4602(c) of the Balanced Budget Act of 1997) is 
        amended--
                    (A) by striking ``For services'' and inserting ``In 
                the case of services''; and
                    (B) by striking ``the following rules apply'' 
                through ``For beneficiaries'' and inserting ``for 
                beneficiaries''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on October 1, 1998.

SEC. 3. INCREASED PAYMENTS FOR HOME HEALTH AGENCIES THAT PROVIDE 
              SERVICES TO CERTAIN BENEFICIARIES.

    (a) Estimate.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall estimate the amount of 
savings (if any) to the Medicare Program under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.) resulting from the 
provisions in this Act for each fiscal year beginning after fiscal year 
1998 and before the first fiscal year in which the prospective payment 
system for home health agencies (established by section 1895 of such 
Act (42 U.S.C. 1395fff)) applies. Each such estimate shall be made not 
later than the first day of the fiscal year, except that in the case of 
fiscal year 1999, such estimate shall be made not later than the 30th 
day after the date of enactment of this Act.
    (b) Increased Payments.--
            (1) In general.--If the Secretary estimates that there will 
        be savings to the Medicare Program pursuant to subsection (a) 
        in a fiscal year, the Secretary shall prescribe rules under 
        which the amount of payments to a home health agency otherwise 
        made for such year under the Medicare Program is increased by a 
        specific amount (determined by the Secretary in regulations) 
        for each beneficiary that has been a patient of such agency for 
        at least 120 consecutive days during such year. The total 
        amount of increased payments made under this section in a 
        fiscal year shall equal the estimated savings for such year.
            (2) Determination of increased payment.--Not later than 
        October 1 of each year (beginning in 1998), the Secretary shall 
        establish the increased payment amount for purposes of 
        paragraph (1) that is applicable for the fiscal year beginning 
        on such date. In the case of fiscal year 1999, the Secretary 
        shall establish such increased payment amount by not later than 
        the 30th day after the date of enactment of this Act.
    (c) Heightened Scrutiny of Certain Claims.--The Secretary shall 
establish procedures to provide heightened scrutiny of claims for 
reimbursement under the Medicare Program for items and services 
provided to beneficiaries described in subsection (b)(1).

SEC. 4. INCREASE IN PER-VISIT COST LIMITS.

    (a) In General.--Section 1861(v)(1)(L)(i)(IV) of the Social 
Security Act (42 U.S.C. 1395x(v)(1)(L)(i)(IV)) (as added by section 
4602 of the Balanced Budget Act of 1997) is amended by striking ``105 
percent'' and inserting ``108 percent''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on October 1, 1998.

SEC. 5. UPDATE ON IMPLEMENTATION OF PROSPECTIVE PAYMENT SYSTEM FOR HOME 
              HEALTH AGENCIES.

    Not later than 90 days after the date of enactment of this Act, and 
every 90 days thereafter until the prospective payment system for home 
health agencies (established by section 1895 of the Social Security Act 
(42 U.S.C. 1395fff)) is implemented, the Secretary of Health and Human 
Services shall meet with the staff of the appropriate committees of 
Congress to provide an informal update regarding the progress of the 
Secretary in implementing such payment system.