I

106TH CONGRESS

2D SESSION H. R. 4727

To amend title XVIII of the Social Security Act with respect to payments

made under the prospective payment system for home health services

furnished under the Medicare Program.

IN THE HOUSE OF REPRESENTATIVES

JUNE 22, 2000

Mr. MCGOVERN (for himself, Mr. HILLEARY, Mr. WEYGAND, and Mr. PETERSON of Pennsylvania) introduced the following bill; which was referred to

the Committee on Ways and Means, and in addition to the Committee

on Commerce, for a period to be subsequently determined by the Speaker,

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend title XVIII of the Social Security Act with respect

to payments made under the prospective payment system

for home health services furnished 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 ‘‘Equal Access to Medi5 care Home Health Care Act of 2000’’.
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1 SEC. 2. FINDINGS.

2 Congress makes the following findings:

3 (1) Over 30,000,000 beneficiaries under the

4 medicare program under title XVIII of the Social

5 Security Act rely on providers of home health serv6 ices to provide them with cost-effective, high quality

7 home health care.

8 (2) The medicare home health benefit enables

9 many medicare beneficiaries to remain at home and

10 to live with dignity and independence despite serious

11 health conditions.

12 (3) The medicare home health benefit helps al13 leviate the burden of medicare beneficiaries on hos14 pitals and skilled nursing facilities, where services

15 provided to medicare beneficiaries are more expen16 sive.

17 (4) The amendments made by the Balanced

18 Budget Act of 1997 to title XVIII of the Social Se19 curity Act were originally projected to cut

20 $16,100,000,000 from the medicare home health

21 benefit between fiscal years 1998 and 2002.

22 (5) The Congressional Budget Office recently

23 projected that those amendments made by the Bal24 anced Budget Act of 1997 will actually cut

25 $69,400,000,000 from the medicare home health

26 benefit between fiscal years 1998 and 2002.
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1 (6) The recent projections by the Congressional

2 Budget Office represent more than 4 times the

3 amount of the reduction in the medicare home

4 health benefit originally projected to take effect as

5 a result of the amendments made by the Balanced

6 Budget Act of 1997.

7 (7) The failure of the Health Care Financing

8 Administration to disburse payments under the in9 terim payment system established by the Balanced

10 Budget Act of 1997 under section 1861(v)(1)(L) of

11 the Social Security Act in a timely manner has re12 sulted in medicare overpayments to thousands of

13 providers of home health services, leaving many of

14 these providers on precarious financial footing.

15 (8) Access to care, particularly for high-cost

16 and long-term patients, has become a growing prob17 lem because the amount of payment for these types

18 of patients under the current interim payment sys19 tem is insufficient.

20 (9) Under the proposed regulation imple21 menting the new prospective payment system, 50

22 percent of the prospective payment amount will be

23 paid upon receipt and processing of the providers

24 initial claim for reimbursement and 50 percent of
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1 that amount will be delayed until the final claim is

2 processed at the end of the 60-day episode period.

3 (10) Medicare beneficiaries incur most home

4 health care expenses during the first 30 days of a

5 60-day episode period and providers of home health

6 services do not have large cash reserves to support

7 delayed payment for those services under the medi8 care program.

9 (11) It is essential that the Administrator of

10 the Health Care Financing Administration ensure

11 that the initial payment to providers of home health

12 services during a 60-day episode period of home

13 health care provided under the medicare home

14 health benefit provides a steady cash flow for those

15 providers so that medicare beneficiaries may con16 tinue to receive necessary home health services.

17 (12) Studies by the Medicare Payment Advisory

18 Commission established under section 1805 of the

19 Social Security Act have indicated that certain popu20 lations of medicare beneficiaries risk not receiving

21 necessary home health services because of the sys22 temic changes made by the Balanced Budget Act of

23 1997.

24 (13) Because the aggregate amount of payment

25 made for all home health services during the first
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1 year in which payment will be made for those serv2 ices under the prospective payment system is limited

3 to the amount that would have been paid in such

4 year for those services under the interim payment

5 system, there is an enormous risk that this limited

6 amount will be insufficient, resulting in a perpetua7 tion of the current crisis under the interim payment

8 system for home health services.

9 SEC. 3. ELIMINATION OF 15 PERCENT REDUCTION IN PAY10 MENT RATES UNDER THE MEDICARE PRO11 SPECTIVE PAYMENT SYSTEM FOR HOME

12 HEALTH SERVICES.

13 (a) IN GENERAL.—Section 1895(b)(3)(A) of the So14 cial Security Act (42 U.S.C. 1395fff(b)(3)(A)), as amend15 ed by sections 302(b) and 303(f) of the Medicare, Med16 icaid, and SCHIP Balanced Budget Refinement Act of

17 1999 (113 Stat. 1501A–359, 361), as enacted into law

18 by section 1000(a)(6) of Public Law 106–113, is amended

19 to read as follows:

20 ‘‘(A) INITIAL BASIS.—Under such system

21 the Secretary shall provide for computation of

22 a standard prospective payment amount (or

23 amounts). Such amount (or amounts) shall ini24 tially be based on the most current audited cost

25 report data available to the Secretary and shall
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1 be computed in a manner so that the total

2 amounts payable under the system for the 12-

3 month period beginning on the date the Sec4 retary implements the system shall be equal to

5 the total amount that would have been made

6 if the system had not been in effect and if sec7 tion 1861(v)(1)(L)(ix) had not been enacted.

8 Each such amount shall be standardized in a

9 manner that eliminates the effect of variations

10 in relative case mix and area wage adjustments

11 among different home health agencies in a

12 budget neutral manner consistent with the case

13 mix and wage level adjustments provided under

14 paragraph (4)(A). Under the system, the Sec15 retary may recognize regional differences or dif16 ferences based upon whether or not the services

17 or agency are in an urbanized area.’’.

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

19 subsection (a) shall take effect as if included in the enact20 ment of the Medicare, Medicaid, and SCHIP Balanced

21 Budget Refinement Act of 1999 (Public Law 106–113).

22 SEC. 4. OVERPAYMENTS.

23 (a) 36-MONTH REPAYMENT PERIOD.—In the case of

24 an overpayment by the Secretary of Health and Human

25 Services to a home health agency for home health services
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1 furnished during a cost reporting period beginning on or

2 after October 1, 1997, as a result of payment limitations

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

4 1861(v)(1)(L) of the Social Security Act (42 U.S.C.

5 1395x(v)(1)(L)), with respect to the repayment by the

6 home health agency of such overpayment, interest shall

7 accrue on the outstanding balance of that overpayment as

8 provided in subsection (b).

9 (b) INTEREST ON OVERPAYMENT AMOUNTS.—

10 (1) 36-MONTH GRACE PERIOD.—No interest

11 shall accrue on the outstanding balance of the

12 amount of overpayment during the 36-month period

13 beginning on the date of notification of the overpay14 ment.

15 (2) OVERDUE BALANCES.—Interest shall accrue

16 on any outstanding balance of the amount of over17 payment after the termination of such 36-month pe18 riod. Interest shall accrue under this paragraph at

19 the rate of interest charged by banks for loans to

20 their most favored commercial customers, as pub21 lished in the Wall Street Journal on the Friday im22 mediately following the date of the enactment of this

23 Act.

24 (c) TERMINATION.—The provisions of this section

25 shall not apply to an overpayment made by the Secretary
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1 of Health and Human Services to a home health agency

2 for cost reporting periods, or portions of cost reporting

3 periods, beginning on or after the date of the implementa4 tion of the prospective payment system for home health

5 services under section 1895 of the Social Security Act (42

6 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. ADDITIONAL PAYMENTS UNDER THE PROSPECTIVE

11 PAYMENT SYSTEM FOR SERVICES FUR12 NISHED IN RURAL AREAS AND SECURITY

13 SERVICES.

14 (a) INCREASE IN PAYMENT RATES FOR RURAL

15 AGENCIES.—Section 1895(b) of the Social Security Act

16 (42 U.S.C. 1395fff(b)) is amended by adding at the end

17 the following new paragraph:

18 ‘‘(7) ADDITIONAL PAYMENT AMOUNT FOR

19 SERVICES FURNISHED IN RURAL AREAS.—In the

20 case of home health services furnished in a rural

21 area (as defined in section 1886(d)(2)(D)), the Sec22 retary shall provide for an addition or adjustment to

23 the payment amount otherwise made under this sec24 tion for services furnished in a rural area in an
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1 amount equal to 10 percent of the amount otherwise

2 determined under this subsection.’’.

3 (b) ADDITIONAL PAYMENT FOR SECURITY SERV4 ICES.—Section 1895(b) of such Act (42 U.S.C.

5 1395fff(b)(3)), as amended by subsection (a), is further

6 amended by adding at the end the following paragraph:

7 ‘‘(8) ADDITIONAL PAYMENT FOR SECURITY

8 SERVICES.—The Secretary shall provide for an addi9 tion or adjustment to the payment amount otherwise

10 made under this section for the reasonable cost (as

11 defined in section 1861(v)(1)(A)) of furnishing pro12 tective services to individuals furnishing home health

13 services under this title in areas where such individ14 uals are at risk of physical harm, as determined by

15 the Secretary.’’.

16 (c) WAIVING BUDGET NEUTRALITY.—Section

17 1895(b)(3) of such Act (42 U.S.C. 1395fff(b)(3)) is

18 amended by adding at the end the following new subpara19 graph:

20 ‘‘(D) NO ADJUSTMENT FOR ADDITIONAL

21 PAYMENTS FOR RURAL SERVICES AND SECU22 RITY SERVICES.—The Secretary shall not re23 duce the standard prospective payment amount

24 (or amounts) under this paragraph applicable

25 to home health services furnished during a pe-
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1 riod to offset the increase in payments resulting

2 from the application of paragraph (7) (relating

3 to services furnished in rural areas) and para4 graph (8) (relating to costs of security serv5 ices).’’.

6 (d) EFFECTIVE DATE.—The amendments made by

7 this section shall take effect on the date that is 270 days

8 after the date of the enactment of this Act.

9 SEC. 6. RULE OF CONSTRUCTION RELATING TO

10 TELEHOMEHEALTH SERVICES.

11 (a) IN GENERAL.—Section 1895(b) of such Act (42

12 U.S.C. 1395fff(b)(3)), as amended by section 3, is further

13 amended by adding at the end the following paragraph:

14 ‘‘(9) RULE OF CONSTRUCTION RELATING TO

15 TELEHOMEHEALTH SERVICES.—

16 ‘‘(A) IN GENERAL.—Nothing in this sec17 tion, or in section 4206(a) of the Balanced

18 Budget Act of 1997 (42 U.S.C. 1395l note),

19 shall be construed as preventing a home health

20 agency receiving payment under this section

21 from furnishing a home health service via a

22 telecommunications system.

23 ‘‘(B) LIMITATION.—The Secretary shall

24 not consider a home health service provided in
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1 the manner described in subparagraph (A) to

2 be a home health visit for purposes of—

3 ‘‘(i) determining the amount of pay4 ment to be made under this section; or

5 ‘‘(ii) any requirement relating to the

6 certification of a physician required under

7 section 1814(a)(2)(C).’’.

8 (b) REPORT.—Not later than one year after the date

9 of the enactment of this Act, the Secretary of Health and

10 Human Services shall submit to Congress a report con11 taining the recommendations of the Secretary with respect

12 to the feasibility and advisability of including home health

13 services furnished by telecommunications systems as a

14 home health service for purposes of—

15 (1) payment for such services under section

16 1895 of the Social Security Act (42 U.S.C. 1395fff),

17 and

18 (2) requirements with respect to physician cer19 tification of the need for home health services under

20 section 1814(a)(2)(C) of such Act (42 U.S.C.

21 1395f(a)(2)(C)).

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