Fairness in Medicare Home Health Access Act of 1999

Summary: Amends the Balanced Budget Act of 1997 to eliminate the 15 percent home health services payment reduction in interim payments which would occur if the Secretary did not establish a prospective payment system (PPS) for such services as provided for in such Act.
Amends SSA title XVIII with regard to the PPS for home health services to reduce the current 15 percent reduction in cost and per beneficiary limits to ten percent, establishing a special rule beginning in FY 2004 that restores the reduction back to its original 15 percent.
Increases the per visit cost limit to 112 percent of the national median.
Provides that in the case of home health services furnished to an individual who (at the time of furnishing) is under a home health agency plan of care, payment for an item of durable medical equipment shall be made to the agency separately from payment for other items and services furnished.
Eliminates timekeeping requirements under the PPS for home health agencies.
Expresses the sense of the Senate that the Secretary should establish a nationally uniform process that ensures that fiscal intermediaries and carriers under Medicare have the training and ability necessary to provide timely, accurate, and consistent coverage and payment information to each home health agency and to each individual eligible to have payment made under Medicare.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``The Fairness in Medicare Home Health 
Access Act of 1999''.

SEC. 2. FINDINGS AND PURPOSES.

    (a) Findings.--Congress finds the following:
            (1) Home health care is a vital component of the medicare 
        program under title XVIII of the Social Security Act.
            (2) Home health services provided under the medicare 
        program enable medicare beneficiaries who are homebound and 
        greatly risk costly institutionalized care to continue to live 
        in their own homes and communities.
            (3) Implementation of the interim payment system for home 
        health services has inadvertently exacerbated payment 
        disparities for home health services among regions, penalizing 
        efficient, low-cost providers in rural areas and providing 
        insufficient compensation for the care of medicare 
        beneficiaries with acute, medically complex conditions.
            (4) The combination of insufficient payments and new 
        administrative changes has reduced the access of medicare 
        beneficiaries to home health services in many areas by forcing 
        home health agencies to provide fewer services, to shrink their 
        service areas, or to limit the types of conditions for which 
        they provide treatment.
    (b) Purposes.--The purposes of this Act are as follows:
            (1) To improve access to care for medicare beneficiaries 
        with high medical needs by establishing a process for home 
        health agencies to exclude services provided to medicare 
        beneficiaries with acute, medically complex conditions from 
        payment limits and to receive payment based on the reasonable 
        costs of providing such services through a process that is 
        feasible for the Health Care Financing Administration to 
        administer.
            (2) To ensure that the 15 percent contingency reduction in 
        medicare payments for home health services established under 
        the Balanced Budget Act of 1997 does not occur under the 
        interim payment system for home health services.
            (3) To reduce the scheduled 15 percent reduction in the 
        cost limits and per beneficiary limits to 10 percent and to 
        phase-in the additional 5 percent reduction in such limits 
        after the initial 3 years of the prospective payment system for 
        home health services.
            (4) To address the unique challenges of serving medicare 
        beneficiaries in rural and underserved areas by increasing the 
        per visit cost limit under the interim payment system for home 
        health services.
            (5) To refine the home health consolidated billing 
        provision to ensure that medicare beneficiaries requiring 
        durable medical equipment services do not experience a break in 
        the continuum of care during episodes of home health care.
            (6) To eliminate the requirement that home health agencies 
        identify the length of time of a service visit in 15 minute 
        increments.
            (7) To express the sense of the Senate that the Secretary 
        of Health and Human Services should establish a uniform process 
        for disseminating information to fiscal intermediaries to 
        ensure timely and accurate information to home health agencies 
        and beneficiaries.

SEC. 3. ADEQUATELY ACCOUNTING FOR THE NEEDS OF MEDICARE BENEFICIARIES 
              WITH ACUTE, MEDICALLY COMPLEX CONDITIONS.

    (a) Waiver of Per Beneficiary Limits for Outliers.--Section 
1861(v)(1)(L) of the Social Security Act (42 U.S.C. 1395x(v)(1)(L)), as 
amended by section 5101 of the Tax and Trade Relief Extension Act of 
1998 (contained in Division J of Public Law 105-277), is amended--
            (1) by redesignating clause (ix) as clause (x); and
            (2) by inserting after clause (viii) the following:
    ``(ix)(I) Notwithstanding the applicable per beneficiary limit 
under clause (v), (vi), or (viii), but subject to the applicable per 
visit limit under clause (i), in the case of a provider that 
demonstrates to the Secretary that with respect to an individual to 
whom the provider furnished home health services appropriate to the 
individual's condition (as determined by the Secretary) at a reasonable 
cost (as determined by the Secretary), and that such reasonable cost 
significantly exceeded such applicable per beneficiary limit because of 
unusual variations in the type or amount of medically necessary care 
required to treat the individual, the Secretary, upon application by 
the provider, shall pay to such provider for such individual such 
reasonable cost.
    ``(II) The total amount of the additional payments made to home 
health agencies pursuant to subclause (I) in any fiscal year shall not 
exceed an amount equal to 2 percent of the amounts that would have been 
paid under this subparagraph in such year if this clause had not been 
enacted.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of enactment of this Act, and apply with 
respect to each application for payment of reasonable costs for 
outliers submitted by any home health agency for cost reporting periods 
ending on or after October 1, 1999.

SEC. 4. PROTECTION OF THE ACCESS OF MEDICARE BENEFICIARIES TO HOME 
              HEALTH SERVICES BY ADDRESSING THE 15 PERCENT CONTINGENCY 
              REDUCTION IN INTERIM PAYMENTS FOR HOME HEALTH SERVICES.

    (a) Elimination of Contingency Reduction.--Section 4603 of the 
Balanced Budget Act of 1997 (42 U.S.C. 1395fff note), as amended by 
section 5101(c)(3) of the Tax and Trade Relief Extension Act of 1998 
(contained in division J of Public Law 105-277), is amended by striking 
subsection (e).
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the enactment of the Balanced Budget Act 
of 1997 (Public Law 105-33; 111 Stat. 251).

SEC. 5. PROTECTION OF THE ACCESS OF MEDICARE BENEFICIARIES TO HOME 
              HEALTH SERVICES THROUGH A PHASE-IN OF THE 15 PERCENT 
              REDUCTION IN PROSPECTIVE PAYMENTS FOR HOME HEALTH 
              SERVICES.

    (a) Phase-In of 15 Percent Reduction.--Section 1895(b)(3)(A)(ii) 
(42 U.S.C. 1395fff(b)), as amended by section 5101(c)(1)(B) of the Tax 
and Trade Relief Extension Act of 1998 (contained in division J of 
Public Law 105-277), is amended--
            (1) in paragraph (3)(A)(ii), by striking ``15'' and 
        inserting ``10''; and
            (2) by adding at the end the following:
            ``(7) Special rule for payments beginning with fiscal year 
        2004.--Beginning with fiscal year 2004, payment under this 
        section shall be made as if `15' had been substituted for `10' 
        in clause (ii) of paragraph (3)(A) when computing the initial 
        basis under such paragraph.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of enactment of this Act.

SEC. 6. INCREASE IN PER VISIT COST LIMIT TO 112 PERCENT OF THE NATIONAL 
              MEDIAN.

    Section 1861(v)(1)(L)(i) of the Social Security Act (42 U.S.C. 
1395x(v)(1)(L)(i)), as amended by section 5101(b) of the Tax and Trade 
Relief Extension Act of 1998 (contained in division J of Public Law 
105-277), is amended--
            (1) in subclause (IV), by striking ``or'';
            (2) in subclause (V)--
                    (A) by inserting ``and before October 1, 1999,'' 
                after ``October 1, 1998,''; and
                    (B) by striking the period and inserting ``, or''; 
                and
            (3) by adding at the end the following:
            ``(VI) October 1, 1999, 112 percent of such median.''.

SEC. 7. REFINEMENT OF HOME HEALTH AGENCY CONSOLIDATED BILLING.

    (a) In General.--Section 1842(b)(6)(F) of the Social Security Act 
(42 U.S.C. 1395u(b)(6)(F)) is amended by striking ``payment shall be 
made to the agency (without regard to whether or not the item or 
service was furnished by the agency, by others under arrangement with 
them made by the agency, or when any other contracting or consulting 
arrangement, or otherwise).'' and inserting ``(i) payment shall be made 
to the agency (without regard to whether or not the item or service was 
furnished by the agency, by others under arrangement with them made by 
the agency, or when any other contracting or consulting arrangement, or 
otherwise); and (ii) in the case of an item of durable medical 
equipment (as defined in section 1861(n)), payment for the item shall 
be made to the agency separately from payment for other items and 
services furnished to such an individual under such plan.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items of durable medical equipment furnished on or after the 
date of enactment of this Act.

SEC. 8. ELIMINATION OF TIMEKEEPING REQUIREMENTS UNDER THE PROSPECTIVE 
              PAYMENT SYSTEM FOR HOME HEALTH AGENCIES.

    (a) In General.--Section 1895(c) of the Social Security Act (42 
U.S.C. 1395fff(c)) is amended--
            (1) by striking ``unless--'' and all that follows through 
        ``(1) the'' and inserting ``unless the''; and
            (2) by striking ``1835(a)(2)(A);'' and all that follows 
        through the period and inserting ``1835(a)(2)(A).''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date of enactment of this Act.

SEC. 9. SENSE OF THE SENATE REGARDING THE TIMELINESS AND ACCURACY OF 
              INTERMEDIARY COMMUNICATIONS TO HOME HEALTH AGENCIES.

    It is the sense of the Senate that the Secretary of Health and 
Human Services should establish a nationally uniform process that 
ensures that each fiscal intermediary (as defined in section 1816(a) of 
the Social Security Act (42 U.S.C. 1395h(a))) and each carrier (as 
defined in section 1842(f) of such Act (42 U.S.C. 1395u(f))) has the 
training and ability necessary to provide timely, accurate, and 
consistent coverage and payment information to each home health agency 
and to each individual eligible to have payment made under the medicare 
program under title XVIII of such Act (42 U.S.C. 1395 et seq.).