Homebound Elderly Relief Opportunity Act of 1998

Summary: Homebound Elderly Relief Opportunity Act of 1998 - Amends title XVIII (Medicare) of the Social Security Act (SSA), as amended by the Balanced Budget Act of 1997 (BBA '97), with respect to the computation formula of the interim system of limited payments for services provided by home health agencies, with a revised formula containing a specific per beneficiary annual limitation according to the census division in which an agency is located. 
(Sec. 2) Declares that such interim system shall not apply for a cost reporting period beginning during FY 1999 through 2002 unless the Secretary of Health and Human Services determines that the amount of the aggregate expenditures for home health services in a fiscal year exceeds specified applicable amounts for FY 1999 and 2002.  Eliminates the special per beneficiary payment rule for new agencies that was added by BBA '97 for determination of the reasonable cost of such services. 
Provides for a three percent increase in per visit cost limits for cost reporting periods beginning on or after October 1, 1998. 
Precludes administrative or judicial review of certain actions by the Secretary with respect to payment limits for cost reporting periods beginning on or after October 1, 1998. 
Amends BBA '97 with regard to the establishment of a prospective payment system (CPPS) for home health care services to repeal the current requirement that during certain applicable cost reporting periods applicable limits under Medicare's reasonable cost requirements be reduced by 15 percent. 
(Sec. 3) Directs the Secretary to report to the Congress on:   (1) research paid for by the Secretary with regard to development of a PPS for Medicare home health services, with a summary of research results; and (2) the schedule for PPS implementation. 
Directs the Medicare Payment Advisory Commission to:  (1) report to the Congress on the Secretary's research report along with recommendations with respect to matters in it; and (2) include in its annual report to the Congress an analysis of whether changes in law made by this Act with regard to payments impede access to home health services by Medicare beneficiaries. 
Directs the Comptroller General to audit expenditures by the Health Care Financing Administration for research costs and audit estimates of aggregate expenditures for Medicare home health services.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Homebound Elderly Relief Opportunity 
Act of 1998''.

SEC. 2. MODIFICATION OF HOME HEALTH SERVICES PAYMENT LIMITS.

    (a) Conditions on Implementation of Per Beneficiary Limits Under 
Interim Payment System.--
            (1) In general.--Section 1861(v)(1)(L) of the Social 
        Security Act (42 U.S.C. 1395x(v)(1)(L)) is amended--
                    (A) in the first sentence of clause (v), by 
                striking ``For'' and inserting ``Subject to clause 
                (iv), for''; and
                    (B) in clause (iv), to read as follows:
    ``(iv)(I) Clause (v) shall not apply for a cost reporting period 
beginning during fiscal year 1999, 2000, 2001, or 2002, unless the 
Secretary determines that the amount of the aggregate expenditures 
under this title for home health services in the fiscal year (as 
estimated by the Secretary) exceeds the applicable amount described in 
subclause (II).
    ``(II) For purposes of subclause (I), the applicable amount for 
fiscal year 1999 is $19,300,000,000, for fiscal year 2000 is 
$19,000,000,000, for fiscal year 2001 is $21,400,000,000, and for 
fiscal year 2002 is $23,100,000,000.
    ``(III) In determining under subclause (I) for a fiscal year 
whether estimated aggregate expenditures exceed the applicable amount, 
the Secretary shall compute, if applicable, the amount by which 
estimated aggregate expenditures were less than or greater than the 
applicable amount for previous fiscal years (beginning with fiscal year 
1999), and apply such amount in the determination of the estimated 
aggregate expenditures for such fiscal year involved. In making 
computations pursuant to the previous sentence, the Secretary shall use 
information from fiscal years in which settled cost reports of all home 
health agencies are available.
    ``(IV) Not later than May 31 of each of fiscal years 1999 through 
2002, the Secretary shall determine the estimated aggregate 
expenditures for home health services to be made during the fiscal 
year.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to cost reporting periods beginning on or after 
        October 1, 1998.
    (b) Establishment of Regionally Uniform Per Beneficiary Limits 
Under Interim Payment System.--
            (1) In general.--Section 1861(v)(1)(L) of such Act (42 
        U.S.C. 1395x(v)(1)(L)) is amended--
                    (A) by amending subclause (I) of clause (v) to read 
                as follows:
            ``(I) the per beneficiary annual limitation specified in 
        clause (viii); and''; and
                    (B) by adding at the end the following new clause:
    ``(viii) For purposes of clause (v)(I), the per beneficiary annual 
limitation is the following amount:
            ``(I) For an agency located in the New England census 
        division (Connecticut, Maine, Massachusetts, New Hampshire, 
        Rhode Island, and Vermont), $4,026.91.
            ``(II) For an agency located in the Middle Atlantic census 
        division (New Jersey, New York, and Pennsylvania), $3,796.19.
            ``(III) For an agency located in the East North Central 
        census division (Illinois, Indiana, Michigan, Ohio, and 
        Wisconsin), $3,943.56.
            ``(IV) For an agency located in the West North Central 
        census division (Iowa, Kansas, Minnesota, Montana, Nebraska, 
        North Dakota, and South Dakota), $3,911.64.
            ``(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), $4,132.02.
            ``(VI) For an agency located in the East South Central 
        census division (Alabama, Kentucky, Mississippi, and 
        Tennessee), $5,641.41.
            ``(VII) For an agency located in the West South Central 
        census division (Arkansas, Louisiana, Oklahoma, and Texas), 
        $5,507.11.
            ``(VIII) For an agency located in the Mountain census 
        division (Arizona, Colorado, Idaho, Montana, Nevada, New 
        Mexico, Utah, and Wyoming), $4,115.74.
            ``(IX) For an agency located in the Pacific census division 
        (Alaska, California, Hawaii, Oregon, and Washington), 
        $3,894.87.
            ``(X) For an agency located in the Commonwealth of Puerto 
        Rico, $3,783.11.
            ``(XI) For an agency located in the Territory of Guam, 
        $3,760.93.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to cost reporting periods beginning on or after 
        October 1, 1998.
    (c) Elimination of Special Per Beneficiary Payment Rule for New 
Agencies.--
            (1) In general.--Section 1861(v)(1)(L)(vi) of such 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'' and 
                all that follows through ``For beneficiaries'' and 
                inserting ``for beneficiaries''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply to cost reporting periods beginning on or after 
        October 1, 1998.
    (d) Per Visit Cost Limits.--Section 1861(v)(1)(L)(i) of such Act 
(42 U.S.C. 1395x(v)(1)(L)(i)) is amended--
            (1) in subclause (III), by striking ``or''; and
            (2) in subclause (IV)--
                    (A) by inserting ``and before October 1, 1998,'' 
                after ``October 1, 1997,'';
                    (B) by striking the period at the end and inserting 
                ``, or''; and
                    (C) by adding at the end the following new 
                subclause:
            ``(V) October 1, 1998, 108 percent of the mean of the 
        labor-related and nonlabor per visit costs for freestanding 
        home health agencies.''.
    (e) Judicial Review.--Section 1861(v)(1)(L) of such Act (42 U.S.C. 
1395x(v)(1)(L)), as amended by subsection (b), is further amended by 
adding at the end the following new clause:
    ``(ix) There shall be no administrative or judicial review under 
section 1869, 1878, or under any other provision of law of any action 
by the Secretary under clause (i), (iv), or (viii), as amended by the 
Homebound Elderly Relief Opportunity Act of 1998, with respect to 
payment limits for cost reporting periods beginning on or after October 
1, 1998.''.
    (f) Publication of New Limits.--Section 1861(v)(1)(L)(vii) of such 
Act (42 U.S.C. 1395x(v)(1)(L)(vii)) is amended by adding at the end the 
following new subclause:
    ``(III) Notwithstanding subclause (II), in the case of per visit or 
per beneficiary limits for fiscal year 1999 established by reason of 
the Homebound Elderly Relief Opportunity Act of 1998, the Secretary 
shall establish such limits by not later than 90 days after the date of 
the enactment of such Act.''.
    (g) Elimination of Mandatory Reduction in Payment Limits.--Section 
4603(e) of the Balanced Budget Act of 1997 (42 U.S.C. 1395fff note) is 
amended by striking ``provide for a reduction by 15 percent in'' and 
inserting ``apply''.

SEC. 3. REPORTS ON INTERIM PAYMENT SYSTEM.

    (a) Summary of Research.--By not later than January 1, 1999, the 
Secretary of Health and Human Services shall submit to Congress a 
report on the following matters:
            (1) Description of research.--A description of any research 
        paid for by the Secretary on the development of a prospective 
        payment system for home health services furnished under the 
        Medicare program under title XVIII of the Social Security Act, 
        and a summary of the results of such research.
            (2) Schedule for implementation of system.--The Secretary's 
        schedule for the implementation of the prospective payment 
        system for home health services under section 1895 of the 
        Social Security Act (42 U.S.C. 1395fff).
    (b) MedPAC Reports.--
            (1) Review of secretary's report.--Not later than 60 days 
        after the date the Secretary of Health and Human Services 
        submits to Congress the report under subsection (a), the 
        Medicare Payment Advisory Commission (established under section 
        1805 of the Social Security Act (42 U.S.C. 1395b-6) shall 
        submit to Congress a report describing the Commission's 
        analysis of the Secretary's report, and shall include the 
        Commission's recommendations with respect to the matters 
        contained in such report.
            (2) Annual report.--The Commission shall include in its 
        annual report to Congress for June 1999 an analysis of whether 
        changes in law made by the Balanced Budget Act of 1997, as 
        modified by the amendments made by this Act, with respect to 
        payments for home health services furnished under the Medicare 
        program under title XVIII of the Social Security Act impede 
        access to such services by individuals entitled to benefits 
        under such program.
    (c) GAO Audits.--
            (1) Research expenditures.--The Comptroller General of the 
        United States shall conduct an audit of sums obligated or 
        expended by the Health Care Financing Administration for the 
        research described in subsection (a)(1), and of the data, 
        reports, proposals, or other information provided by such 
        research.
            (2) Estimates of aggregate spending for medicare home 
        health services.--The Comptroller General shall conduct an 
        audit of the estimated aggregate expenditures for home health 
        services furnished under the Medicare program, as determined by 
        the Secretary of Health and Human Services under section 
        1861(v)(1)(L)(iv)(IV) of the Social Security Act (42 U.S.C. 
        1395x(v)(1)(L)(iv)(IV)), as added by section 2(b), for each of 
        fiscal years 1999 through 2002.