II 

116TH CONGRESS 

1ST SESSION S. 433 

To amend title XVIII of the Social Security Act to improve home health 

payment reforms under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 11, 2019 

Ms. COLLINS (for herself, Ms. STABENOW, Mr. KENNEDY, Mr. JONES, Mr. 

CASSIDY, Mr. PAUL, and Mrs. SHAHEEN) 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 improve 

home health payment reforms under the Medicare program. 

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 Payment 

5 Innovation Act of 2019’’. 

6 SEC. 2. IMPROVEMENTS TO MEDICARE INNOVATIONS AND 

7 MANAGED CARE RELATED TO HOME HEALTH 

8 SERVICES. 

9 (a) EXPANDED WAIVERS IN SHARED SAVINGS PRO10 GRAMS.—Section 1899(f) of the Social Security Act (42 


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1 U.S.C. 395jjj(f)), is amended by adding at the end the 

2 following: ‘‘Beginning not later than January 1, 2020, the 

3 Secretary shall include a waiver of the ‘confined to his 

4 home’ requirement under sections 1814(a)(2)(C) and 

5 1835(a)(2)(A) in one or more programs under this sec6 tion.’’. 

7 (b) FLEXIBILITY IN MEDICARE ADVANTAGE

8 PLANS.—Section 1852 of the Social Security Act (42 

9 U.S.C. 1395ww–2) is amended by adding at the end the 

10 following: 

11 ‘‘(o) FLEXIBILITY IF PROVIDING HOME HEALTH

12 SERVICES.—Notwithstanding any other provision of law, 

13 any MA organization shall be permitted to waive the ‘con14 fined to his home’ requirement in the home health services 

15 benefit when the organization determines it is in the best 

16 interest of the enrollee.’’. 

17 SEC. 3. IMPROVEMENTS TO HOME HEALTH PAYMENT RE18 FORMS UNDER MEDICARE. 

19 (a) APPLICATION OF BUDGET NEUTRALITY.—Sec20 tion 1895(b)(3) of the Social Security Act (42 U.S.C. 

21 1395fff(b)(3)), as amended by section 51001(a)(2) of the 

22 Bipartisan Budget Act of 2018 (Public Law 115–123), 

23 is amended— 

24 (1) in subparagraph (A)(iv), in the fourth sen25 tence— 


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1 (A) by striking ‘‘shall make’’ and inserting 

2 ‘‘shall not make’’; and 

3 (B) by striking ‘‘and shall provide a de4 scription’’ and all that follows through the pe5 riod and inserting a period; and 

6 (2) in subparagraph (D)— 

7 (A) in the subparagraph heading, by strik8 ing ‘‘ASSUMPTIONS’’ and inserting ‘‘EVIDENCE’’; 

9 (B) in clause (i)— 

10 (i) by striking ‘‘differences between 

11 assumed’’ and all that follows through 

12 ‘‘and actual’’; 

13 (ii) by inserting ‘‘attributable to the 

14 implementation of paragraphs (2)(B) and 

15 (4)(B)’’ after ‘‘behavior changes’’; and 

16 (iii) by adding at the end the fol17 lowing: ‘‘The Secretary shall publish the 

18 determination under this clause with re19 spect to an applicable year, including a de20 scription of the evidence used to make such 

21 determination, in the notice and comment 

22 rulemaking to update the prospective pay23 ment system under this subsection for such 

24 year. For purposes of the preceding sen25 tence, the term ‘evidence’ means the most 


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1 recent data after January 1, 2020, that re2 flects the difference between real changes 

3 in case mix and behavioral changes relat4 ing to implementation of the provisions of 

5 and amendments made by section 51001 of 

6 the Bipartisan Budget Act of 2018 (Public 

7 Law 115–123).’’; 

8 (C) in clause (ii), by inserting ‘‘attrib9 utable to the implementation of paragraphs 

10 (2)(B) and (4)(B)’’ after ‘‘expenditures’’; and 

11 (D) in clause (iii)— 

12 (i) by adding ‘‘attributable to the im13 plementation of paragraphs (2)(B) and 

14 (4)(B)’’ after ‘‘expenditures’’; and 

15 (ii) by adding at the end the fol16 lowing: ‘‘If such a temporary increase or 

17 decrease does not exceed 2.00 percent in 

18 any given year, the Secretary shall apply 

19 the entire increase or decrease in the next 

20 calendar year payment update. In the case 

21 where such a temporary increase or de22 crease exceeds 2.00, the Secretary shall 

23 phase in the temporary increase or de24 crease in equal amounts not to exceed 2.00 

25 percent in any given year through the reVerDate Sep 11 2014 02:07 Feb 23, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S433.IS S433

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1 spective calendar year payment updates. 

2 Notwithstanding the preceding sentence, 

3 the Secretary shall complete any such 

4 phase-in adjustment no later than 2029 

5 and shall have the authority, after 2025, to 

6 waive the phase-in requirement as nec7 essary to achieve budget neutrality by 

8 2029. Prior to implementing such phase-in 

9 adjustments after 2025, the Secretary 

10 shall first receive certification from the Of11 fice of the Actuary of the Centers for 

12 Medicare & Medicaid Services that any 

13 such adjustments are appropriate.’’. 

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

15 this section shall take effect as if included in the enact16 ment of such section 51001(a)(2). 

Æ 


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