I 

116TH CONGRESS 

1ST SESSION H. R. 2573 

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

payment reforms under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 8, 2019 

Ms. SEWELL of Alabama (for herself, Mr. BUCHANAN, Mr. ABRAHAM, Ms. 

KUSTER of New Hampshire, Mr. LARSON of Connecticut, Mr. MARCHANT, Mr. GRAVES of Louisiana, Mr. ARRINGTON, Mr. THORNBERRY, Mr. 

PANETTA, and Mr. DESJARLAIS) introduced the following bill; which was 

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

Committee on Energy and 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 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’’. 


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1 SEC. 2. IMPROVEMENTS TO MEDICARE INNOVATIONS AND 

2 MANAGED CARE RELATED TO HOME HEALTH 

3 SERVICES. 

4 (a) EXPANDED WAIVERS IN SHARED SAVINGS PRO5 GRAMS.—Section 1899(f) of the Social Security Act (42 

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

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

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

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

10 1835(a)(2)(A) in one or more programs under this sec11 tion.’’. 

12 (b) FLEXIBILITY IN MEDICARE ADVANTAGE

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

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

15 following: 

16 ‘‘(o) FLEXIBILITY IF PROVIDING HOME HEALTH

17 SERVICES.—Notwithstanding any other provision of law, 

18 any MA organization shall be permitted to waive the ‘con19 fined to his home’ requirement in the home health services 

20 benefit when the organization determines it is in the best 

21 interest of the enrollee.’’. 

22 SEC. 3. IMPROVEMENTS TO HOME HEALTH PAYMENT RE23 FORMS UNDER MEDICARE. 

24 (a) APPLICATION OF BUDGET NEUTRALITY.—Sec25 tion 1895(b)(3) of the Social Security Act (42 U.S.C. 

26 1395fff(b)(3)), as amended by section 51001(a)(2) of the 


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

2 is amended— 

3 (1) in subparagraph (A)(iv), in the fourth sen4 tence— 

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

6 ‘‘shall not make’’; and 

7 (B) by striking ‘‘and shall provide a de8 scription’’ and all that follows through the pe9 riod and inserting a period; and 

10 (2) in subparagraph (D)— 

11 (A) in the subparagraph heading, by strik12 ing ‘‘ASSUMPTIONS’’ and inserting ‘‘EVIDENCE’’; 

13 (B) in clause (i)— 

14 (i) by striking ‘‘differences between 

15 assumed’’ and all that follows through 

16 ‘‘and actual’’; 

17 (ii) by inserting ‘‘attributable to the 

18 implementation of paragraphs (2)(B) and 

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

20 (iii) by adding at the end the fol21 lowing: ‘‘The Secretary shall publish the 

22 determination under this clause with re23 spect to an applicable year, including a de24 scription of the evidence used to make such 

25 determination, in the notice and comment 


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1 rulemaking to update the prospective pay2 ment system under this subsection for such 

3 year. For purposes of the preceding sen4 tence, the term ‘evidence’ means the most 

5 recent data after January 1, 2020, that re6 flects the difference between real changes 

7 in case mix and behavioral changes relat8 ing to implementation of the provisions of 

9 and amendments made by section 51001 of 

10 the Bipartisan Budget Act of 2018 (Public 

11 Law 115–123).’’; 

12 (C) in clause (ii), by inserting ‘‘attrib13 utable to the implementation of paragraphs 

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

15 (D) in clause (iii)— 

16 (i) by adding ‘‘attributable to the im17 plementation of paragraphs (2)(B) and 

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

19 (ii) by adding at the end the fol20 lowing: ‘‘If such a temporary increase or 

21 decrease does not exceed 2.00 percent in 

22 any given year, the Secretary shall apply 

23 the entire increase or decrease in the next 

24 calendar year payment update. In the case 

25 where such a temporary increase or deVerDate Sep 11 2014 03:30 May 15, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2573.IH H2573

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1 crease exceeds 2.00 percent, the Secretary 

2 shall phase in the temporary increase or 

3 decrease in equal amounts not to exceed 

4 2.00 percent in any given year through the 

5 respective calendar year payment updates. 

6 Notwithstanding the preceding sentence, 

7 the Secretary shall complete any such 

8 phase-in adjustment no later than 2029 

9 and shall have the authority, after 2025, to 

10 waive the phase-in requirement as nec11 essary to achieve budget neutrality by 

12 2029. Prior to implementing such phase-in 

13 adjustments after 2025, the Secretary 

14 shall first receive certification from the Of15 fice of the Actuary of the Centers for 

16 Medicare & Medicaid Services that any 

17 such adjustments are appropriate.’’. 

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

19 this section shall take effect as if included in the enact20 ment of such section 51001(a)(2). 

Æ 


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