II

106TH CONGRESS

1ST SESSION S. 1310

To amend title XVIII of the Social Security Act to modify the interim

payment system for home health services, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 30, 1999

Ms. COLLINS (for herself, Mr. BOND, Mr. LEVIN, Mr. BENNETT, Mr.

SANTORUM, Mrs. HUTCHISON, Mr. TORRICELLI, Mr. LUGAR, Mr. ALLARD, Mr. SPECTER, Mr. EDWARDS, Mr. BROWNBACK, Mr. LAUTENBERG, Mr. COCHRAN, Mr. ENZI, Mr. FRIST, Mr. HELMS, and Mr. ABRAHAM) introduced the following bill; which was read twice and referred to

the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to modify

the interim payment system for home health services,

and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Home Health Equity

5 Act of 1999’’.

6 SEC. 2. ELIMINATION OF AUTOMATIC 15 PERCENT REDUC7 TION IN HOME HEALTH PAYMENTS.

8 (a) IN GENERAL.—
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1 (1) CONTINGENCY REDUCTION.—Section 4603

2 of the Balanced Budget Act of 1997 (Public Law

3 105–33) (42 U.S.C. 1395fff note), as amended by

4 section 5101(c)(3) of the Tax and Trade Relief Ex5 tension Act of 1998 (contained in Division J of Pub6 lic Law 105–277), is amended by striking subsection

7 (e).

8 (2) PROSPECTIVE PAYMENT SYSTEM.—Section

9 1895(b)(3)(A) of the Social Security Act (42 U.S.C.

10 1395fff(b)(3)(A)) is amended—

11 (A) by striking ‘‘INITIAL BASIS.—’’ and all

12 that follows through ‘‘Under such system’’, and

13 inserting ‘‘INITIAL BASIS.—Under such sys14 tem’’;

15 (B) in clause (i), by striking ‘‘but if the re16 duction in limits described in clause (ii) had

17 been in effect’’; and

18 (C) by striking clause (ii).

19 SEC. 3. OUTLIER PAYMENTS.

20 (a) WAIVER OF PER BENEFICIARY LIMITS FOR

21 OUTLIERS.—

22 (1) IN GENERAL.—Section 1861(v)(1)(L) of the

23 Social Security Act (42 U.S.C. 1395x(v)(1)(L)), as

24 amended by section 5101(a) of the Tax and Trade
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1 Relief Extension Act of 1998 (contained in Division

2 J of Public Law 105–277) is amended—

3 (A) by redesignating clause (ix) as clause

4 (x); and

5 (B) by inserting after clause (viii) the fol6 lowing:

7 ‘‘(ix)(I) Notwithstanding the applicable per bene8 ficiary limit under clause (v), (vi), or (viii), but subject

9 to the applicable per visit limit under clause (i), in the

10 case of a provider that demonstrates to the Secretary that

11 with respect to an individual to whom the provider fur12 nished home health services appropriate to the individual’s

13 condition (as determined by the Secretary) at a reasonable

14 cost (as determined by the Secretary), and that such rea15 sonable cost significantly exceeded such applicable per

16 beneficiary limit because of unusual variations in the type

17 or amount of medically necessary care required to treat

18 the individual, the Secretary, upon application by the pro19 vider, shall pay to such provider for such individual such

20 reasonable cost.

21 ‘‘(II)(aa) The Secretary shall establish such criteria

22 as is required for payment under this clause, including a

23 description of the type of individual, condition, unusual

24 variations, and home health service that qualifies for such

25 payment.
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1 ‘‘(bb) In establishing criteria under item (aa), the

2 Secretary shall consider the information gathered in order

3 to establish case mix adjustment factors under section

4 1895(b)(4)(B) and any available Outcomes and Assess5 ment Information Set (OASIS) case mix data.

6 ‘‘(III) In making determinations under subclause (I),

7 the Secretary shall use data from the cost report, or from

8 other data collected by the Secretary, of the provider for

9 such year.

10 ‘‘(IV) A provider may make an application for pay11 ment under this clause for a fiscal year no earlier than

12 the end of the cost reporting period beginning in such fis13 cal year.

14 ‘‘(V) The total amount of the additional payments

15 made to home health agencies pursuant to subclause (I)

16 in any fiscal year shall not be less than an amount equal

17 to 3 percent of the amounts that would have been paid

18 under this subparagraph in such year if this clause had

19 not been enacted and shall not exceed 4 percent of such

20 amounts.’’.

21 (b) EFFECTIVE DATE.—The amendment made by

22 subsection (a) shall take effect on the date of enactment

23 of this Act, and apply with respect to each application for

24 payment of reasonable costs for outliers submitted by any
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1 home health agency for cost reporting periods ending on

2 or after September 30, 1999.

3 SEC. 4. RECOUPMENT OF OVERPAYMENTS.

4 (a) 36-MONTH REPAYMENT PERIOD.—

5 (1) IN GENERAL.—Except as provided in para6 graph (2), in the case of an overpayment by the Sec7 retary of Health and Human Services to a home

8 health agency for home health services furnished

9 during a cost reporting period beginning on or after

10 October 1, 1997, as a result of payment limitations

11 provided for under clause (v), (vi), or (viii) of section

12 1861(v)(1)(L) of the Social Security Act (42 U.S.C.

13 1395x(v)(1)(L)), the home health agency may elect

14 to repay the amount of such overpayment over a 36-

15 month period beginning on the date of notification

16 of such overpayment.

17 (2) EXCEPTION.—No home health agency may

18 make an election under paragraph (1) if any final

19 adverse action (as defined in section 1128E(g)(1))

20 has been taken against such agency.

21 (b) NO INTEREST ON OVERPAYMENT AMOUNTS.—In

22 the case of an agency that makes an election under sub23 section (a), no interest shall accrue on the outstanding

24 balance of the amount of overpayment during such 36-

25 month period.
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1 (c) TERMINATION.—No election under subsection (a)

2 may be made for cost reporting periods, or portions of cost

3 reporting periods beginning on or after the date of the

4 implementation of the prospective payment system for

5 home health services under section 1895 of the Social Se6 curity Act (42 U.S.C. 1395fff).

7 (d) EFFECTIVE DATE.—The provisions of subsection

8 (a) shall take effect as if included in the enactment of the

9 Balanced Budget Act of 1997.

10 SEC. 5. INCREASE IN PAYMENT AMOUNT TO AGENCIES

11 WITH LIMITS UNDER THE NATIONAL AVER12 AGE.

13 (a) IN GENERAL.—Section 1861(v)(1)(L)(viii)(I) of

14 the Social Security Act (42 U.S.C.

15 1395x(v)(1)(L)(viii)(I)), as added by section 5101(a)(3) of

16 the Tax and Trade Relief Extension Act of 1998 (con17 tained in Division J of Public Law 105–277), is amended

18 by striking ‘‘the limit otherwise imposed under clause (v)’’

19 and all that follows through the period and inserting ‘‘the

20 limit for such provider and period shall be an amount

21 equal to—

22 ‘‘(aa) for cost reporting periods beginning dur23 ing fiscal year 1999, 90 percent of such median;

24 ‘‘(bb) for cost reporting periods beginning dur25 ing fiscal year 2000, 95 percent of such median; and
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1 ‘‘(cc) for cost reporting periods beginning dur2 ing or after fiscal year 2001, such median.’’.

3 (b) EFFECTIVE DATE.—The provisions of subsection

4 (a) shall take effect as if included in the enactment of the

5 Tax and Trade Relief Extension Act of 1998 (contained

6 in Division J of Public Law 105–277).

7 SEC. 6. INCREASE IN PER VISIT LIMIT.

8 Section 1861(v)(1)(L)(i) of the Social Security Act

9 (42 U.S.C. 1395x(v)(1)(L)(i)), as amended by section

10 5101(a) of the Tax and Trade Relief Extension Act of

11 1998 (contained in Division J of Public Law 105–277),

12 is amended—

13 (1) in subclause (IV), by striking ‘‘or’’;

14 (2) in subclause (V)—

15 (A) by inserting ‘‘and before October 1,

16 1999,’’ after ‘‘October 1, 1998,’’; and

17 (B) by striking the period and inserting ‘‘,

18 or’’; and

19 (3) by adding at the end the following:

20 ‘‘(VI) October 1, 1999, 108 percent of such me21 dian.’’.
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1 SEC. 7. ELIMINATION OF TIMEKEEPING REQUIREMENTS

2 UNDER THE PROSPECTIVE PAYMENT SYSTEM

3 FOR HOME HEALTH AGENCIES.

4 (a) IN GENERAL.—Section 1895(c) of the Social Se5 curity Act (42 U.S.C. 1395fff(c)) is amended—

6 (1) by striking ‘‘unless—’’ and all that follows

7 through ‘‘(1) the’’ and inserting ‘‘unless the’’; and

8 (2) by striking ‘‘1835(a)(2)(A);’’ and all that

9 follows through the period and inserting

10 ‘‘1835(a)(2)(A).’’.

11 (b) EFFECTIVE DATE.—The amendments made by

12 subsection (a) shall take effect on the date of enactment

13 of this Act.

14 SEC. 8. PERIODIC INTERIM PAYMENT FOR CERTAIN HOME

15 HEALTH AGENCIES.

16 (a) IN GENERAL.—Section 1815(e)(2)(D) of the So17 cial Security Act (42 U.S.C. 1395g(e)(2)(D)) is amended

18 by inserting ‘‘until the end of the 12-month period fol19 lowing the date that the prospective payment system for

20 such services is implemented pursuant to section 1895’’

21 after ‘‘services’’.

22 (b) CONFORMING AMENDMENT.—Section 4603(b) of

23 the Balanced Budget Act of 1997 (Public Law 105–33)

24 is repealed.

25 (c) EFFECTIVE DATE.—The amendment made by

26 this section shall take effect as if included in the enact-
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1 ment of the Balanced Budget Act of 1997 (Public Law

2 105–33).

3 SEC. 9. REVISION OF SURETY BOND REQUIREMENT FOR

4 HOME HEALTH AGENCIES.

5 (a) IN GENERAL.—Section 1861(o) of the Social Se6 curity Act (42 U.S.C. 1395x(o)) is amended by inserting

7 after the first sentence the following: ‘‘The surety bond

8 required under paragraph (7) shall be used by the Sec9 retary to protect against overpayments made to an agency

10 based on fraudulent claims or behavior but shall not be

11 used to protect against overpayments that are not based

12 on such claims or behavior.’’.

13 (b) EFFECTIVE DATE.—The amendment made by

14 subsection (a) shall take effect on the date of enactment

15 of this Act.

16 SEC. 10. EXCLUSION OF ADDITIONAL PART B COSTS FROM

17 DETERMINATION OF PART B MONTHLY PRE18 MIUM.

19 Section 1839(g) of the Social Security Act (42 U.S.C.

20 1395r(g)) (as added by section 5101(e) of the Tax and

21 Trade Relief Extension Act of 1998 (contained in division

22 J of Public Law 105–277)) is amended by striking ‘‘sec23 tion 1861(v)(1)(L)(viii) or to the establishment under sec24 tion 1861(v)(1)(L)(i)(V) of a per visit limit at 106 percent

25 of the median (instead of 105 percent of the median)’’
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1 and inserting ‘‘clauses (viii) and (ix) of section

2 1861(v)(1)(L) or to the establishment under section

3 1861(v)(1)(L)(i)(V) of a per visit limit at 106 percent and

4 108 percent of the median (instead of 105 percent of the

5 median and 106 percent of the median, respectively)’’.

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