Home Health Equity Act of 1999

Summary: Provides for: (1) outlier payments to home health agencies (agencies) in spite of applicable per beneficiary payment limits when a provider demonstrates to the Secretary that an individual was furnished appropriate home health services at a reasonable cost that significantly exceeded such applicable per beneficiary limit because of certain conditions; and (2) recoupment of overpayments by the Secretary to agencies over a 36-month period as specified.
Makes various Medicare amendments under reasonable cost provisions with regard to an increase in payment amounts to agencies with limits under the national average and an increase in the per visit limit for cost reporting periods beginning on or after October 1, 1999, with regard to the amount of payments that may be made under Medicare for services furnished by agencies.
Eliminates timekeeping requirements under the prospective payment system for home health services.
Provides for periodic interim payment for certain agencies under Medicare provisions regarding payment to service providers.
Revises surety bond requirements for agencies.
Excludes additional Medicare part B (Supplementary Medical Insurance) costs from determination of the Medicare part B premium.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Home Health Equity Act of 1999''.

SEC. 2. ELIMINATION OF AUTOMATIC 15 PERCENT REDUCTION IN HOME HEALTH 
              PAYMENTS.

    (a) In General.--
            (1) Contingency reduction.--Section 4603 of the Balanced 
        Budget Act of 1997 (Public Law 105-33) (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).
            (2) Prospective payment system.--Section 1895(b)(3)(A) of 
        the Social Security Act (42 U.S.C. 1395fff(b)(3)(A)) is 
        amended--
                    (A) by striking ``Initial basis.--'' and all that 
                follows through ``Under such system'', and inserting 
                ``Initial basis.--Under such system'';
                    (B) in clause (i), by striking ``but if the 
                reduction in limits described in clause (ii) had been 
                in effect''; and
                    (C) by striking clause (ii).

SEC. 3. OUTLIER PAYMENTS.

    (a) Waiver of Per Beneficiary Limits for Outliers.--
            (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 
        5101(a) of the Tax and Trade Relief Extension Act of 1998 
        (contained in Division J of Public Law 105-277) is amended--
                    (A) by redesignating clause (ix) as clause (x); and
                    (B) 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)(aa) The Secretary shall establish such criteria as is 
required for payment under this clause, including a description of the 
type of individual, condition, unusual variations, and home health 
service that qualifies for such payment.
    ``(bb) In establishing criteria under item (aa), the Secretary 
shall consider the information gathered in order to establish case mix 
adjustment factors under section 1895(b)(4)(B) and any available 
Outcomes and Assessment Information Set (OASIS) case mix data.
    ``(III) In making determinations under subclause (I), the Secretary 
shall use data from the cost report, or from other data collected by 
the Secretary, of the provider for such year.
    ``(IV) A provider may make an application for payment under this 
clause for a fiscal year no earlier than the end of the cost reporting 
period beginning in such fiscal year.
    ``(V) The total amount of the additional payments made to home 
health agencies pursuant to subclause (I) in any fiscal year shall not 
be less than an amount equal to 3 percent of the amounts that would 
have been paid under this subparagraph in such year if this clause had 
not been enacted and shall not exceed 4 percent of such amounts.''.
    (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 September 30, 1999.

SEC. 4. RECOUPMENT OF OVERPAYMENTS.

    (a) 36-Month Repayment Period.--
            (1) In general.--Except as provided in paragraph (2), in 
        the case of an overpayment by the Secretary of Health and Human 
        Services to a home health agency for home health services 
        furnished during a cost reporting period beginning on or after 
        October 1, 1997, as a result of payment limitations provided 
        for under clause (v), (vi), or (viii) of section 1861(v)(1)(L) 
        of the Social Security Act (42 U.S.C. 1395x(v)(1)(L)), the home 
        health agency may elect to repay the amount of such overpayment 
        over a 36-month period beginning on the date of notification of 
        such overpayment.
            (2) Exception.--No home health agency may make an election 
        under paragraph (1) if any final adverse action (as defined in 
        section 1128E(g)(1)) has been taken against such agency.
    (b) No Interest on Overpayment Amounts.--In the case of an agency 
that makes an election under subsection (a), no interest shall accrue 
on the outstanding balance of the amount of overpayment during such 36-
month period.
    (c) Termination.--No election under subsection (a) may be made for 
cost reporting periods, or portions of cost reporting periods beginning 
on or after the date of the implementation of the prospective payment 
system for home health services under section 1895 of the Social 
Security Act (42 U.S.C. 1395fff).
    (d) Effective Date.--The provisions of subsection (a) shall take 
effect as if included in the enactment of the Balanced Budget Act of 
1997.

SEC. 5. INCREASE IN PAYMENT AMOUNT TO AGENCIES WITH LIMITS UNDER THE 
              NATIONAL AVERAGE.

    (a) In General.--Section 1861(v)(1)(L)(viii)(I) of the Social 
Security Act (42 U.S.C. 1395x(v)(1)(L)(viii)(I)), as added by section 
5101(a)(3) of the Tax and Trade Relief Extension Act of 1998 (contained 
in Division J of Public Law 105-277), is amended by striking ``the 
limit otherwise imposed under clause (v)'' and all that follows through 
the period and inserting ``the limit for such provider and period shall 
be an amount equal to--
            ``(aa) for cost reporting periods beginning during fiscal 
        year 1999, 90 percent of such median;
            ``(bb) for cost reporting periods beginning during fiscal 
        year 2000, 95 percent of such median; and
            ``(cc) for cost reporting periods beginning during or after 
        fiscal year 2001, such median.''.
    (b) Effective Date.--The provisions of subsection (a) shall take 
effect as if included in the enactment of the Tax and Trade Relief 
Extension Act of 1998 (contained in Division J of Public Law 105-277).

SEC. 6. INCREASE IN PER VISIT LIMIT.

    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(a) 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, 108 percent of such median.''.

SEC. 7. 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. 8. PERIODIC INTERIM PAYMENT FOR CERTAIN HOME HEALTH AGENCIES.

    (a) In General.--Section 1815(e)(2)(D) of the Social Security Act 
(42 U.S.C. 1395g(e)(2)(D)) is amended by inserting ``until the end of 
the 12-month period following the date that the prospective payment 
system for such services is implemented pursuant to section 1895'' 
after ``services''.
    (b) Conforming Amendment.--Section 4603(b) of the Balanced Budget 
Act of 1997 (Public Law 105-33) is repealed.
    (c) Effective Date.--The amendment made by this section shall take 
effect as if included in the enactment of the Balanced Budget Act of 
1997 (Public Law 105-33).

SEC. 9. REVISION OF SURETY BOND REQUIREMENT FOR HOME HEALTH AGENCIES.

    (a) In General.--Section 1861(o) of the Social Security Act (42 
U.S.C. 1395x(o)) is amended by inserting after the first sentence the 
following: ``The surety bond required under paragraph (7) shall be used 
by the Secretary to protect against overpayments made to an agency 
based on fraudulent claims or behavior but shall not be used to protect 
against overpayments that are not based on such claims or behavior.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of enactment of this Act.

SEC. 10. EXCLUSION OF ADDITIONAL PART B COSTS FROM DETERMINATION OF 
              PART B MONTHLY PREMIUM.

    Section 1839(g) of the Social Security Act (42 U.S.C. 1395r(g)) (as 
added by section 5101(e) of the Tax and Trade Relief Extension Act of 
1998 (contained in division J of Public Law 105-277)) is amended by 
striking ``section 1861(v)(1)(L)(viii) or to the establishment under 
section 1861(v)(1)(L)(i)(V) of a per visit limit at 106 percent of the 
median (instead of 105 percent of the median)'' and inserting ``clauses 
(viii) and (ix) of section 1861(v)(1)(L) or to the establishment under 
section 1861(v)(1)(L)(i)(V) of a per visit limit at 106 percent and 108 
percent of the median (instead of 105 percent of the median and 106 
percent of the median, respectively)''.