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[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 659 Introduced in Senate (IS)]

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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Home Health Care Access Protection 
Act of 2011''.

SEC. 2. PROTECTING ACCESS TO MEDICARE HOME HEALTH SERVICES.

    Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C. 
1395fff(b)(3)(B)) is amended--
            (1) in clause (iv), by striking ``Insofar as'' and 
        inserting ``Subject to clause (vii), insofar as''; and
            (2) by adding at the end the following new clause:
                            ``(vii) Special rules for adjustment for 
                        case mix changes for 2012 and subsequent 
                        years.--
                                    ``(I) In general.--For 2012 and 
                                each subsequent year, subject to 
                                subclause (IV), any adjustment under 
                                clause (iv) shall only be made using 
                                standards established by the Secretary 
                                consistent with the processes described 
                                in subclause (II) and taking into 
                                account the considerations described in 
                                subclause (III).
                                    ``(II) Processes and criteria for 
                                evaluating changes in case mix.--For 
                                purposes of subclause (I), the 
                                processes described in this subclause 
                                are the following:
                                            ``(aa) The Secretary shall 
                                        convene a Technical Advisory 
                                        Group to advise the Secretary 
                                        concerning the establishment of 
                                        standards under subclause (I) 
                                        in order to distinguish between 
                                        real changes in case mix and 
                                        changes in coding or 
                                        classification of different 
                                        units of services that do not 
                                        reflect real changes in case 
                                        mix. The Technical Advisory 
                                        Group shall be composed of 
                                        stakeholders, including an 
                                        equal number of individuals and 
                                        organizations representing the 
                                        interests of Medicare 
                                        beneficiaries, the National 
                                        Association for Home Care and 
                                        Hospice, the Visiting Nurse 
                                        Associations of America, health 
                                        care academia, and health care 
                                        professionals. Members shall 
                                        not have an existing 
                                        contractual relationship with 
                                        the Secretary at the time of 
                                        their appointment to the 
                                        Technical Advisory Group. The 
                                        Secretary shall provide the 
                                        Technical Advisory Group an 
                                        opportunity to review and 
                                        comment on any proposed 
                                        rulemaking or final 
                                        determination of the Secretary 
                                        with respect to such standards 
                                        prior to the issuance of the 
                                        proposed rulemaking or making 
                                        of the final determination.
                                            ``(bb) If the Secretary 
                                        engages an outside contractor 
                                        to participate in the 
                                        evaluation of case mix changes 
                                        described in item (aa), the 
                                        Secretary shall only utilize an 
                                        outside contractor that has not 
                                        previously participated in the 
                                        design and establishment of the 
                                        case mix adjustment factors 
                                        under paragraph (4)(B).
                                            ``(cc) If the Secretary 
                                        determines that any increase in 
                                        case mix relates to changes in 
                                        the volume or nature of home 
                                        health services provided, the 
                                        Secretary shall evaluate that 
                                        increase through the actual 
                                        review of claims and services 
                                        and shall not use any proxy or 
                                        surrogate for determining 
                                        whether the change in volume or 
                                        nature of services is 
                                        reasonable and necessary.
                                            ``(dd) The Secretary shall 
                                        establish such standards by 
                                        regulation.
                                            ``(ee) The Secretary shall 
                                        make available to the public 
                                        all data, reports, and 
                                        supporting materials, including 
                                        any comments by the Technical 
                                        Advisory Group under item (aa), 
                                        regarding the establishment of 
                                        such standards at the time of 
                                        the publication of the notice 
                                        of the proposed regulation.
                                    ``(III) Considerations.--For 
                                purposes of subclause (I), the 
                                considerations described in this 
                                subclause are the following:
                                            ``(aa) The impact of 
                                        changes in the program under 
                                        this title that may affect the 
                                        characteristics of individuals 
                                        receiving home health services.
                                            ``(bb) The impact of 
                                        changes in the provision of 
                                        home health services by 
                                        providers of services and 
                                        suppliers other than home 
                                        health agencies.
                                            ``(cc) Distinctions in the 
                                        characteristics of individuals 
                                        initiating home health services 
                                        from community and 
                                        institutional care settings.
                                            ``(dd) Whether any changes 
                                        in coding resulted in a change 
                                        in aggregate payments under 
                                        this subsection during the 
                                        fiscal year or year and 
                                        disregarding changes in coding 
                                        that did not result in such a 
                                        change in aggregate payments.
                                            ``(ee) Any other factors 
                                        determined appropriate by the 
                                        Secretary, in consultation with 
                                        the Technical Advisory Group 
                                        under subclause (II)(aa).
                                    ``(IV) Exception for certain 
                                adjustments for 2012.--This clause 
                                shall not apply to any adjustment under 
                                clause (iv) that is scheduled in a 
                                final rule for 2012 as of January 1, 
                                2011.''.
                                 <all>
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