II 

112TH CONGRESS 

1ST SESSION S. 659 

To amend title XVIII of the Social Security Act to protect Medicare 

beneficiaries’ access to home health services under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

MARCH 29, 2011 

Ms. COLLINS (for herself and Ms. CANTWELL) 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 protect 

Medicare beneficiaries’ access to home health services 

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 Care 

5 Access Protection Act of 2011’’. 

6 SEC. 2. PROTECTING ACCESS TO MEDICARE HOME HEALTH 

7 SERVICES. 

8 Section 1895(b)(3)(B) of the Social Security Act (42 

9 U.S.C. 1395fff(b)(3)(B)) is amended— 


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1 (1) in clause (iv), by striking ‘‘Insofar as’’ and 

2 inserting ‘‘Subject to clause (vii), insofar as’’; and 

3 (2) by adding at the end the following new 

4 clause: 

5 ‘‘(vii) SPECIAL RULES FOR ADJUST6 MENT FOR CASE MIX CHANGES FOR 2012

7 AND SUBSEQUENT YEARS.— 

8 ‘‘(I) IN GENERAL.—For 2012 

9 and each subsequent year, subject to 

10 subclause (IV), any adjustment under 

11 clause (iv) shall only be made using 

12 standards established by the Secretary 

13 consistent with the processes de14 scribed in subclause (II) and taking 

15 into account the considerations de16 scribed in subclause (III). 

17 ‘‘(II) PROCESSES AND CRITERIA

18 FOR EVALUATING CHANGES IN CASE

19 MIX.—For purposes of subclause (I), 

20 the processes described in this sub21 clause are the following: 

22 ‘‘(aa) The Secretary shall 

23 convene a Technical Advisory 

24 Group to advise the Secretary 

25 concerning the establishment of 


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1 standards under subclause (I) in 

2 order to distinguish between real 

3 changes in case mix and changes 

4 in coding or classification of dif5 ferent units of services that do 

6 not reflect real changes in case 

7 mix. The Technical Advisory 

8 Group shall be composed of 

9 stakeholders, including an equal 

10 number of individuals and orga11 nizations representing the inter12 ests of Medicare beneficiaries, the 

13 National Association for Home 

14 Care and Hospice, the Visiting 

15 Nurse Associations of America, 

16 health care academia, and health 

17 care professionals. Members shall 

18 not have an existing contractual 

19 relationship with the Secretary at 

20 the time of their appointment to 

21 the Technical Advisory Group. 

22 The Secretary shall provide the 

23 Technical Advisory Group an op24 portunity to review and comment 

25 on any proposed rulemaking or 


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1 final determination of the Sec2 retary with respect to such stand3 ards prior to the issuance of the 

4 proposed rulemaking or making 

5 of the final determination. 

6 ‘‘(bb) If the Secretary en7 gages an outside contractor to 

8 participate in the evaluation of 

9 case mix changes described in 

10 item (aa), the Secretary shall 

11 only utilize an outside contractor 

12 that has not previously partici13 pated in the design and establish14 ment of the case mix adjustment 

15 factors under paragraph (4)(B). 

16 ‘‘(cc) If the Secretary deter17 mines that any increase in case 

18 mix relates to changes in the vol19 ume or nature of home health 

20 services provided, the Secretary 

21 shall evaluate that increase 

22 through the actual review of 

23 claims and services and shall not 

24 use any proxy or surrogate for 

25 determining whether the change 


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1 in volume or nature of services is 

2 reasonable and necessary. 

3 ‘‘(dd) The Secretary shall 

4 establish such standards by regu5 lation. 

6 ‘‘(ee) The Secretary shall 

7 make available to the public all 

8 data, reports, and supporting 

9 materials, including any com10 ments by the Technical Advisory 

11 Group under item (aa), regarding 

12 the establishment of such stand13 ards at the time of the publica14 tion of the notice of the proposed 

15 regulation. 

16 ‘‘(III) CONSIDERATIONS.—For 

17 purposes of subclause (I), the consid18 erations described in this subclause 

19 are the following: 

20 ‘‘(aa) The impact of changes 

21 in the program under this title 

22 that may affect the characteris23 tics of individuals receiving home 

24 health services. 


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1 ‘‘(bb) The impact of changes 

2 in the provision of home health 

3 services by providers of services 

4 and suppliers other than home 

5 health agencies. 

6 ‘‘(cc) Distinctions in the 

7 characteristics of individuals ini8 tiating home health services from 

9 community and institutional care 

10 settings. 

11 ‘‘(dd) Whether any changes 

12 in coding resulted in a change in 

13 aggregate payments under this 

14 subsection during the fiscal year 

15 or year and disregarding changes 

16 in coding that did not result in 

17 such a change in aggregate pay18 ments. 

19 ‘‘(ee) Any other factors de20 termined appropriate by the Sec21 retary, in consultation with the 

22 Technical Advisory Group under 

23 subclause (II)(aa). 

24 ‘‘(IV) EXCEPTION FOR CERTAIN

25 ADJUSTMENTS FOR 2012.—This clause 


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1 shall not apply to any adjustment 

2 under clause (iv) that is scheduled in 

3 a final rule for 2012 as of January 1, 

4 2011.’’. 

Æ 


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