I

106TH CONGRESS

2D SESSION H. R. 5163

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

SEPTEMBER 13, 2000

Mr. MCGOVERN (for himself, Mr. PETERSON of Pennsylvania, Mr. HILLIARD,

Mr. WATKINS, Mr. JEFFERSON, Mr. ENGLISH, Mr. MCINTOSH, Mrs.

THURMAN, Mr. HILLEARY, Mr. WEYGAND, Mr. SANDERS, Mr. COOK, Mr.

RAHALL, Mr. TIERNEY, Mr. MOAKLEY, Mr. WAMP, Mr. POMEROY, Mr.

CONYERS, Mr. GOODE, Mr. DICKEY, Mr. DOYLE, Mr. FRANK of Massachusetts, Mr. NEY, Ms. MILLENDER-MCDONALD, Mr. ROMERO-BARCELO ́

,

Mr. FROST, Mr. KIND, Mr. BALDACCI, Mr. OLVER, Mr. MURTHA, Mr.

GOODLING, and Mr. ALLEN) 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,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Home Health Refine3 ment Amendments of 2000’’.

4 SEC. 2. ELIMINATION OF 15 PERCENT REDUCTION IN PAY5 MENT RATES UNDER THE MEDICARE PRO6 SPECTIVE PAYMENT SYSTEM FOR HOME

7 HEALTH SERVICES.

8 (a) IN GENERAL.—Section 1895(b)(3)(A) of the So9 cial Security Act (42 U.S.C. 1395fff(b)(3)(A)), as amend10 ed by sections 302(b) and 303(f) of the Medicare, Med11 icaid, and SCHIP Balanced Budget Refinement Act of

12 1999 (113 Stat. 1501A–359, 361), as enacted into law

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

14 to read as follows:

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

16 the Secretary shall provide for computation of

17 a standard prospective payment amount (or

18 amounts). Such amount (or amounts) shall ini19 tially be based on the most current audited cost

20 report data available to the Secretary and shall

21 be computed in a manner so that the total

22 amounts payable under the system for the 12-

23 month period beginning on the date the Sec24 retary implements the system shall be equal to

25 the total amount that would have been made if

26 the system had not been in effect and if section
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1 1861(v)(1)(L)(ix) had not been enacted. Each

2 such amount shall be standardized in a manner

3 that eliminates the effect of variations in rel4 ative case mix and area wage adjustments

5 among different home health agencies in a

6 budget neutral manner consistent with the case

7 mix and wage level adjustments provided under

8 paragraph (4)(A). Under the system, the Sec9 retary may recognize regional differences or dif10 ferences based upon whether or not the services

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

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

13 subsection (a) shall take effect as if included in the enact14 ment of the Medicare, Medicaid, and SCHIP Balanced

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

16 SEC. 3. ADDITIONAL PAYMENTS FOR OUTLIERS.

17 (a) IN GENERAL.—Section 1895(b)(5) of the Social

18 Security Act (42 U.S.C. 1395fff(b)(5)) is amended—

19 (1) by striking ‘‘OUTLIERS.—The Secretary’’

20 and inserting the following (and conforming the in21 dentation of the succeeding matter accordingly):

22 ‘‘OUTLIERS.—

23 ‘‘(A) IN GENERAL.—The Secretary’’; and

24 (2) by adding at the end the following new sub25 paragraph:
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1 ‘‘(B) TEMPORARY ADDITIONAL PAYMENTS

2 FOR OUTLIERS.—For the purposes described in

3 the first sentence of subparagraph (A), there

4 are authorized to be appropriated from the

5 trust funds (as defined in section 1896(a)(8))

6 in appropriate part, as determined by the Sec7 retary, for each of fiscal years 2001 through

8 2005 an amount equal to $500,000,000. Such

9 amounts shall be in addition to amounts avail10 able for payment under this section and shall

11 not result in an reduction of the standard pro12 spective payment amount (or amounts). In

13 making payments under this subparagraph, the

14 Secretary shall use a loss-sharing ratio of 90

15 percent.’’.

16 (b) CONFORMING AMENDMENT.—Section

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

18 is amended by striking ‘‘paragraph (5)’’ and inserting

19 ‘‘paragraph (5)(A)’’.

20 SEC. 4. ADDITIONAL PAYMENTS UNDER THE PROSPECTIVE

21 PAYMENT SYSTEM FOR SERVICES FUR22 NISHED IN RURAL AREAS AND SECURITY

23 SERVICES.

24 (a) INCREASE IN PAYMENT RATES FOR RURAL

25 AGENCIES.—Section 1895(b) of the Social Security Act
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1 (42 U.S.C. 1395fff(b)) is amended by adding at the end

2 the following new paragraph:

3 ‘‘(7) ADDITIONAL PAYMENT AMOUNT FOR

4 SERVICES FURNISHED IN RURAL AREAS.—In the

5 case of home health services furnished in a rural

6 area (as defined in section 1886(d)(2)(D)), notwith7 standing any other provision of this subsection, the

8 amount of payment for such services is equal to 110

9 percent of the payment amount otherwise made

10 under this section (but for this paragraph) for serv11 ices furnished in a rural area.’’.

12 (b) ADDITIONAL PAYMENT FOR SECURITY SERV13 ICES.—Section 1895(b) of such Act (42 U.S.C.

14 1395fff(b)(3)), as amended by subsection (a), is further

15 amended by adding at the end the following paragraph:

16 ‘‘(8) ADDITIONAL PAYMENT FOR SECURITY

17 SERVICES.—The Secretary shall provide for an addi18 tion or adjustment to the payment amount otherwise

19 made under this section for the reasonable cost (as

20 defined in section 1861(v)(1)(A)) of furnishing pro21 tective services to individuals furnishing home health

22 services under this title in areas where such individ23 uals are at risk of physical harm, as determined by

24 the Secretary.’’.
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1 (c) INAPPLICABILITY OF ADJUSTMENTS FOR BUDG2 ET NEUTRALITY.—Section 1895(b)(3) of such Act (42

3 U.S.C. 1395fff(b)(3)) is amended by adding at the end

4 the following new subparagraph:

5 ‘‘(D) NO ADJUSTMENT FOR ADDITIONAL

6 PAYMENTS FOR RURAL SERVICES AND SECU7 RITY SERVICES.—The Secretary shall not re8 duce the standard prospective payment amount

9 (or amounts) under this paragraph applicable

10 to home health services furnished during a pe11 riod to offset the increase in payments resulting

12 from the application of paragraph (7) (relating

13 to services furnished in rural areas) and para14 graph (8) (relating to costs of security serv15 ices).’’.

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

17 this section apply with respect to items and services fur18 nished on or after October 1, 2000.

19 SEC. 5. EXCLUSION OF NONROUTINE MEDICAL SUPPLIES

20 UNDER THE PPS FOR HOME HEALTH SERV21 ICES.

22 (a) IN GENERAL.—Section 1895 of the Social Secu23 rity Act (42 U.S.C. 1395fff) is amended by adding at the

24 end the following new subsection:
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1 ‘‘(e) EXCLUSION OF NONROUTINE MEDICAL SUP2 PLIES.—

3 ‘‘(1) IN GENERAL.—Notwithstanding the pre4 ceding provisions of this section, in the case of all

5 nonroutine medical supplies (as defined by the Sec6 retary) furnished by a home health agency during a

7 year (beginning with 2001) for which payment is

8 otherwise made on the basis of the prospective pay9 ment amount under this section, payment under this

10 section shall instead be based on the lesser of—

11 ‘‘(A) the actual charge for the nonroutine

12 medical supply, or

13 ‘‘(B) the amount determined for such sup14 ply under the applicable fee schedule under part

15 B.

16 ‘‘(2) BUDGET NEUTRALITY ADJUSTMENT.—The

17 Secretary shall provide for an appropriate propor18 tional reduction in payments under this section so

19 that beginning with fiscal year 2001, the aggregate

20 amount of such reductions is equal to the aggregate

21 increase in payments (as estimated by the Secretary)

22 attributable to the exclusion effected under para23 graph (1).’’.

24 (b) CONFORMING AMENDMENTS.—(1) Section

25 1895(b)(1) of the Social Security Act (42 U.S.C.
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1 1395fff(b)(1)) is amended by striking ‘‘The Secretary’’

2 and inserting ‘‘Subject to subsection (e), the Secretary’’.

3 (2) Sections 1842(b)(6)(F) and 1862(a)(21) of the

4 Social Security Act (42 U.S.C. 1395u(b)(6)(F);

5 1395y(a)(21)) are each amended by striking ‘‘(including

6 medical supplies described in section 1861(m)(5), but ex7 cluding durable medical equipment to the extent provided

8 for in such section)’’ and inserting ‘‘(other than medical

9 supplies and durable medical equipment described in sec10 tion 1861(m)(5))’’.

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

12 this section apply with respect to items and services fur13 nished on or after October 1, 2000.

14 SEC. 6. RULE OF CONSTRUCTION RELATING TO

15 TELEHOMEHEALTH SERVICES.

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

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

18 amended by adding at the end the following paragraph:

19 ‘‘(9) RULE OF CONSTRUCTION RELATING TO

20 TELEHOMEHEALTH SERVICES.—

21 ‘‘(A) IN GENERAL.—Nothing in this sec22 tion, or in section 4206(a) of the Balanced

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

24 shall be construed as preventing a home health

25 agency receiving payment under this section
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1 from furnishing a home health service via a

2 telecommunications system. Each home health

3 agency that submits a cost report to the Sec4 retary under this section shall include, in such

5 cost report, data with respect to the costs in6 curred in furnishing home health services to

7 medicare beneficiaries via such telecommuni8 cations systems.

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

10 not consider a home health service provided in

11 the manner described in subparagraph (A) to

12 be a home health visit for purposes of—

13 ‘‘(i) determining the amount of pay14 ment to be made under this section; or

15 ‘‘(ii) any requirement relating to the

16 certification of a physician required under

17 section 1814(a)(2)(C).’’.

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

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

20 Human Services shall submit to Congress a report con21 taining the recommendations of the Secretary with respect

22 to the feasibility and advisability of including home health

23 services furnished by telecommunications systems as a

24 home health service for purposes of—
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1 (1) payment for such services under section

2 1895 of the Social Security Act (42 U.S.C. 1395fff),

3 and

4 (2) requirements with respect to physician cer5 tification of the need for home health services under

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

7 1395f(a)(2)(C)).

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