II

105TH CONGRESS

2D SESSION S. 2031

To combat waste, fraud, and abuse in payments for home health services

provided under the medicare program, and to improve the quality of

those home health services.

IN THE SENATE OF THE UNITED STATES

MAY 5, 1998

Mr. GRASSLEY (for himself and Mr. BREAUX) introduced the following bill;

which was read twice and referred to the Committee on Finance

A BILL

To combat waste, fraud, and abuse in payments for home

health services provided under the medicare program,

and to improve the quality of those home health services.

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; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Home Health Integrity Preservation Act of 1998’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Revision of surety bond requirement for home health agencies.

Sec. 3. Additional conditions of participation for home health agencies.

Sec. 4. Surveyor training in reimbursement and coverage policies.
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Sec. 5. Surveys and reviews.

Sec. 6. Prior patient load.

Sec. 7. Establishment of standards and procedures to improve quality of services.

Sec. 8. Notification of availability of a home health agency’s most recent survey

as part of discharge planning process.

Sec. 9. Home health integrity task force.

Sec. 10. Application of certain provisions of the bankruptcy code.

Sec. 11. Study and report to Congress.

Sec. 12. Effective date.

1 SEC. 2. REVISION OF SURETY BOND REQUIREMENT FOR

2 HOME HEALTH AGENCIES.

3 (a) IN GENERAL.—Section 1861(o)(7) of the Social

4 Security Act (42 U.S.C. 1395x(o)) (as added by section

5 4312(b) of the Balanced Budget Act of 1997) is amended

6 to read as follows:

7 ‘‘(7) provides the Secretary, prior to the initial

8 certification of the home health agency and for 1

9 year thereafter, with a surety bond against fraudu10 lent or abusive activities in a form specified by the

11 Secretary and in an amount equal to $25,000; and’’.

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

13 subsection (a) shall take effect on the date of enactment

14 of this Act.

15 SEC. 3. ADDITIONAL CONDITIONS OF PARTICIPATION FOR

16 HOME HEALTH AGENCIES.

17 (a) QUALIFICATIONS OF MANAGING EMPLOYEES.—

18 Section 1891(a) of the Social Security Act (42 U.S.C.

19 1395bbb(a)) is amended by adding at the end the follow20 ing:
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1 ‘‘(7) The agency shall have—

2 ‘‘(A) sufficient knowledge, as attested by

3 the managing employees (as defined in section

4 1126(b)) of the agency (pursuant to subsection

5 (c)(2)(C)(iv)(II)) using standards established by

6 the Secretary, of the requirements for reim7 bursement under this title, coverage criteria

8 and claims procedures, and the civil and crimi9 nal penalties for noncompliance with such re10 quirements; and

11 ‘‘(B) managing employees with sufficient

12 prior education or work experience, according to

13 standards determined by the Secretary, in the

14 delivery of health care.’’.

15 (b) COMPLIANCE PROGRAM.—Section 1891(a) of the

16 Social Security Act (42 U.S.C. 1395bbb(a)) (as amended

17 by subsection (a)) is amended by adding at the end the

18 following:

19 ‘‘(8) The agency has developed and imple20 mented a fraud and abuse compliance program.’’.

21 (c) AVAILABILITY OF SURVEY.—Section 1891(a) of

22 the Social Security Act (42 U.S.C. 1395bbb(a)) (as

23 amended by subsection (b)) is amended by adding at the

24 end the following:
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1 ‘‘(9) The agency, before the agency provides

2 any home health services to a beneficiary, makes

3 available to the beneficiary or the representative of

4 the beneficiary a summary of the pertinent findings

5 (including a list of any deficiencies) of the most re6 cent survey of the agency relating to the compliance

7 of such agency. Such summary shall be provided in

8 a standardized format and may, at the discretion of

9 the Secretary, also include other information regard10 ing the agency’s operations that are of potential in11 terest to beneficiaries, such as the number of pa12 tients served by the agency.’’.

13 (d) NOTICE OF NEW HOME HEALTH SERVICE, NEW

14 BRANCH OFFICE, AND NEW JOINT VENTURE.—Section

15 1891(a)(2) of the Social Security Act (42 U.S.C.

16 1395bbb(a)(2)) is amended to read as follows:

17 ‘‘(2)(A) The agency notifies the agency’s fiscal

18 intermediary and the State entity responsible for the

19 licensing or certification of the agency—

20 ‘‘(i) of a change in the persons with an

21 ownership or control interest (as defined in sec22 tion 1124(a)(3)) in the agency,

23 ‘‘(ii) of a change in the persons who are of24 ficers, directors, agents, or managing employees

25 (as defined in section 1126(b)) of the agency,
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1 ‘‘(iii) of a change in the corporation, asso2 ciation, or other company responsible for the

3 management of the agency,

4 ‘‘(iv) that the agency is providing a cat5 egory of skilled service that it was not providing

6 at the time of the agency’s most recent stand7 ard survey,

8 ‘‘(v) that the agency is operating a new

9 branch office that was not in operation at the

10 time of the agency’s most recent standard sur11 vey, and

12 ‘‘(vi) that the agency is involved in a new

13 joint venture with other health care providers or

14 other business entities.

15 ‘‘(B) The notice required under subparagraph

16 (A) shall be provided—

17 ‘‘(i) for a change described in clauses (i),

18 (ii), and (iii) of such subparagraph, within 30

19 calendar days of the time of the change and

20 shall include the identity of each new person or

21 company described in the previous sentence,

22 ‘‘(ii) for a change described in clause (iv)

23 of such subparagraph, within 30 calendar days

24 of the time the agency begins providing the new
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1 service and shall include a description of the

2 service,

3 ‘‘(iii) for a change described in clause (v)

4 of such subparagraph, within 30 calendar days

5 of the time the new branch office begins oper6 ations and shall include the location of the of7 fice and a description of the services that are

8 being provided at the office, and

9 ‘‘(iv) for a change described in clause (vi)

10 of such subparagraph, within 30 calendar days

11 of the time the agency enters into the joint ven12 ture agreement and shall include a description

13 of the joint venture and the participants in the

14 joint venture.’’.

15 SEC. 4. SURVEYOR TRAINING IN REIMBURSEMENT AND

16 COVERAGE POLICIES.

17 Section 1891(d)(3) of the Social Security Act (42

18 U.S.C. 1395bbb(d)(3)) is amended—

19 (1) by striking ‘‘relating to the performance’’

20 and inserting ‘‘relating to—

21 ‘‘(A) the performance’’;

22 (2) by striking the period at the end and insert23 ing ‘‘; and’’; and

24 (3) by adding at the end the following:
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1 ‘‘(B) requirements for reimbursement and cov2 erage of services under this title.’’.

3 SEC. 5. SURVEYS AND REVIEWS.

4 (a) ADDITIONAL REQUIREMENTS FOR SURVEY.—

5 Section 1891(c)(2)(C) of the Social Security Act (42

6 U.S.C. 1395bbb(c)(2)(C)) is amended—

7 (1) in clause (i)(I)—

8 (A) by striking ‘‘purpose of evaluating’’

9 and inserting ‘‘purpose of—

10 ‘‘(aa) evaluating’’; and

11 (B) by adding at the end the following:

12 ‘‘(bb) evaluating whether the individ13 uals are homebound for purposes of quali14 fying for receipt of benefits for home

15 health services under this title; and’’;

16 (2) in clause (ii), by striking ‘‘and’’ at the end;

17 (3) in clause (iii), by striking the period at the

18 end and inserting ‘‘; and’’; and

19 (4) by adding at the end the following:

20 ‘‘(iv) shall include—

21 ‘‘(I) an assessment of whether the agency

22 is in compliance with all of the conditions of

23 participation and requirements specified in or

24 pursuant to section 1861(o), this section, and

25 this title;
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1 ‘‘(II) an assessment that the managing

2 employees (as defined in section 1126(b)) of the

3 agency have attested in writing to having suffi4 cient knowledge, as determined by the Sec5 retary, of the requirements for reimbursement

6 under this title, coverage criteria and claims

7 procedures, and the civil and criminal penalties

8 for noncompliance with such requirements; and

9 ‘‘(III) a review of the services provided by

10 subcontractors of the agency to ensure that

11 such services are being provided in a manner

12 consistent with the requirements of this title.’’.

13 (b) ADDITIONAL EVENTS TRIGGERING A SURVEY.—

14 Section 1891(c)(2)(B) of the Social Security Act (42

15 U.S.C. 1395bbb(c)(2)(B)) is amended—

16 (1) by striking ‘‘and’’ at the end of clause (i);

17 (2) by striking the period at the end of clause

18 (ii) and inserting a comma; and

19 (3) by adding at the end the following:

20 ‘‘(iii) shall be conducted not less than

21 annually for the first 2 years after the ini22 tial standard survey of the agency;

23 ‘‘(iv) after the agency’s first 2 years

24 of participation under this title, shall be

25 conducted within 90 calendar days of the
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1 date that the agency notifies the Secretary

2 that it is providing a category of skilled

3 service that the agency was not providing

4 at the time of the agency’s most recent

5 standard survey;

6 ‘‘(v) if the agency is operating a new

7 branch office that was not in operation at

8 the time of the agency’s most recent stand9 ard survey, shall be conducted within the

10 12-month period following the date that

11 the new branch office began operations to

12 ensure that such office is providing quality

13 care and that it is appropriately classified

14 as a branch office, and shall include direct

15 scrutiny of the operations of the branch of16 fice; and

17 ‘‘(vi) shall be conducted on randomly

18 selected agencies on an occasional basis,

19 with the number of such surveys to be de20 termined by the Secretary.’’.

21 (c) REVIEW BY FISCAL INTERMEDIARY.—Section

22 1816 of the Social Security Act (42 U.S.C. 1395h) is

23 amended by adding at the end the following:

24 ‘‘(m) An agreement with an agency or organization

25 under this section shall require that the agency or organi-
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1 zation conduct a review of the overall business structure

2 of a home health agency submitting a claim for reimburse3 ment for home health services, including any related orga4 nizations of the home health agency.’’.

5 SEC. 6. PRIOR PATIENT LOAD.

6 Section 1891 of the Social Security Act (42 U.S.C.

7 1395bbb) is amended by adding at the end the following:

8 ‘‘(h) PRIOR PATIENT LOAD.—

9 ‘‘(1) IN GENERAL.—The Secretary shall not

10 enter into an agreement for the first time with a

11 home health agency to provide items and services

12 under this title unless the Secretary determines that,

13 before the date the agreement is entered into, the

14 agency—

15 ‘‘(A) had been in operation for at least 60

16 calendar days; and

17 ‘‘(B) had at least 10 patients during that

18 period of prior operation.

19 ‘‘(2) EXCEPTIONS.—

20 ‘‘(A) BENEFICIARY ACCESS.—If the Sec21 retary determines appropriate, the Secretary

22 may waive the requirements of paragraph (1) in

23 order to establish or maintain beneficiary access

24 to home health services in an area.
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1 ‘‘(B) CHANGE OF OWNERSHIP.—The re2 quirements of paragraph (1) shall not apply to

3 a home health agency at the time of a change

4 in ownership of such agency.’’.

5 SEC. 7. ESTABLISHMENT OF STANDARDS AND PROCE6 DURES TO IMPROVE QUALITY OF SERVICES.

7 (a) IN GENERAL.—Section 1891 of the Social Secu8 rity Act (42 U.S.C. 1395bbb) (as amended by section 6)

9 is amended by adding at the end the following:

10 ‘‘(i) ESTABLISHMENT OF STANDARDS AND PROCE11 DURES.—

12 ‘‘(1) SCREENING OF EMPLOYEES.—The Sec13 retary shall establish procedures to improve the

14 background screening performed by a home health

15 agency on individuals that the agency is considering

16 hiring as home health aides (as defined in subsection

17 (a)(3)(E)) and licensed health professionals (as de18 fined in subsection (a)(3)(F)).

19 ‘‘(2) COST REPORTS.—The Secretary shall es20 tablish additional procedures regarding the require21 ment for attestation of cost reports to ensure greater

22 accountability on the part of a home health agency

23 and its managing employees (as defined in section

24 1126(b)) for the accuracy of the information pro25 vided to the Secretary in any such cost reports.
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1 ‘‘(3) MONITORING AGENCY AFTER EXTENDED

2 SURVEY.—The Secretary shall establish procedures

3 to ensure that a home health agency that is subject

4 to an extended (or partial extended) survey is closely

5 monitored from the period immediately following the

6 extended survey through the agency’s subsequent

7 standard survey to ensure that the agency is in com8 pliance with all the conditions of participation and

9 requirements specified in or pursuant to section

10 1861(o), this section, and this title.

11 ‘‘(4) ADDITIONAL AUDITS.—

12 ‘‘(A) IN GENERAL.—

13 ‘‘(i) STANDARDS.—The Secretary

14 shall establish objective standards regard15 ing the determination of—

16 ‘‘(I) whether an agency is a home

17 health agency described in subpara18 graph (B); and

19 ‘‘(II) the circumstances that trig20 ger an audit for a home health agency

21 described in subparagraph (B), and

22 the content of such an audit.

23 ‘‘(ii) INFORMATION.—In establishing

24 standards under clause (i), the Secretary

25 shall ensure that the individuals perform-
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1 ing the audits under this section are pro2 vided with the necessary information, in3 cluding information from intermediaries,

4 carriers, and law enforcement sources, in

5 order to determine if a particular home

6 health agency is an agency described in

7 subparagraph (B) and whether the cir8 cumstances triggering an audit for such an

9 agency has occurred.

10 ‘‘(B) AGENCY DESCRIBED.—A home health

11 agency is described in this subparagraph if it is

12 an agency that has—

13 ‘‘(i) experienced unusually rapid

14 growth as compared to other home health

15 agencies in the area and in the country;

16 ‘‘(ii) had unusually high utilization

17 patterns as compared to other home health

18 agencies in the area and in the country;

19 ‘‘(iii) unusually high costs per patient

20 as compared to other home health agencies

21 in the area and in the country;

22 ‘‘(iv) unusually high levels of overpay23 ment or coverage denials as compared to

24 other home health agencies in the area and

25 in the country; or
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1 ‘‘(v) operations that otherwise raise

2 concerns such that the Secretary deter3 mines that an audit is appropriate.

4 ‘‘(5) BRANCH OFFICES.—

5 ‘‘(A) SURVEYS.—The Secretary shall es6 tablish standards for periodic surveys of branch

7 offices of a home health agency in order to as8 sess whether the branch offices meet the Sec9 retary’s national criteria for branch office des10 ignation and for quality of care. Such surveys

11 shall include home visits to beneficiaries served

12 by the branch office (but only with the consent

13 of the beneficiary).

14 ‘‘(B) UNIFORM NATIONAL DEFINITION.—

15 The Secretary shall establish a uniform national

16 definition of a branch office of a home health

17 agency.

18 ‘‘(6) CERTAIN QUALIFICATIONS OF MANAGING

19 EMPLOYEES.—The Secretary shall establish stand20 ards regarding the knowledge and prior education or

21 work experience that a managing employee (as de22 fined in section 1126(b)) of an agency must possess

23 in order to comply with the requirements described

24 in subsection (a)(7).

25 ‘‘(7) CLAIMS PROCESSING.—
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1 ‘‘(A) IN GENERAL.—The Secretary shall

2 establish standards to improve and strengthen

3 the procedures by which claims for reimburse4 ment by home health agencies are identified as

5 being fraudulent, wasteful, or abusive.

6 ‘‘(B) PROCEDURES.—The standards estab7 lished by the Secretary pursuant to subpara8 graph (A) shall include, to the extent prac9 ticable, standards for a minimum number of—

10 ‘‘(i) intensive focused medical reviews

11 of the services provided to beneficiaries by

12 an agency;

13 ‘‘(ii) interviews with beneficiaries, em14 ployees of the agency, and other individ15 uals providing services on behalf of the

16 agency; and

17 ‘‘(iii) random spot checks of visits to

18 a beneficiary’s home by employees of the

19 agency (but only with the consent of the

20 beneficiary).

21 ‘‘(C) REPORT TO CONGRESS.—Not later

22 than 90 days after the date of enactment of the

23 Home Health Integrity Preservation Act of

24 1998, the Secretary shall submit a report to

25 Congress containing a detailed description of—
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1 ‘‘(i) the current levels of activity by

2 the Secretary with regard to the reviews,

3 interviews, and spot checks described in

4 subparagraph (B); and

5 ‘‘(ii) the Secretary’s plans to increase

6 those levels pursuant to the procedures de7 scribed in subparagraphs (A) and (B).

8 ‘‘(8) EXPANSION OF FINANCIAL STATEMENT.—

9 The Secretary shall establish procedures to expand

10 the financial statement audit process to include com11 pliance and integrity reviews.’’.

12 (b) EFFECTIVE DATE.—By not later than 180 cal13 endar days after the date of enactment of this Act, the

14 Secretary shall establish the standards and procedures de15 scribed in paragraphs (1) through (8) of section 1891(i)

16 of the Social Security Act (42 U.S.C. 1395bbb(i)) (as

17 added by subsection (a)) by regulation or other sufficient

18 means.

19 SEC. 8. NOTIFICATION OF AVAILABILITY OF A HOME

20 HEALTH AGENCY’S MOST RECENT SURVEY AS

21 PART OF DISCHARGE PLANNING PROCESS.

22 Section 1861(ee)(2)(D) of the Social Security Act (42

23 U.S.C. 1395x(ee)(2)(D)) (as amended by section 4321(a)

24 of the Balanced Budget Act of 1997) is amended—
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1 (1) by striking ‘‘including the availability’’ and

2 inserting ‘‘including—

3 ‘‘(i) the availability’’; and

4 (2) by inserting before the period the following:

5 ‘‘; and

6 ‘‘(ii) the availability of (and procedures for

7 obtaining from a home health agency) a sum8 mary document described in section

9 1891(a)(9)’’.

10 SEC. 9. HOME HEALTH INTEGRITY TASK FORCE.

11 (a) ESTABLISHMENT.—The Secretary of Health and

12 Human Services (in this section referred to as the ‘‘Sec13 retary’’) shall establish within the Office of the Inspector

14 General of the Department of Health and Human Services

15 a home health integrity task force (in this section referred

16 to as the ‘‘Task Force’’).

17 (b) DIRECTOR.—The Inspector General of the De18 partment of Health and Human Services shall appoint the

19 Director of the Task Force.

20 (c) DUTIES.—The Task Force shall target, inves21 tigate, and pursue any available civil or criminal actions

22 against individuals who organize, direct, finance, or are

23 otherwise engaged in fraud in the provision of home health

24 services (as defined in section 1861(m) of the Social Secu-
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1 rity Act (42 U.S.C. 1395x(m))) under the medicare pro2 gram under such Act.

3 (d) OUTSIDE AGENCIES AND ENTITIES.—In carrying

4 out the duties described in subsection (c), the Task Force

5 shall work in coordination with other Federal, State, and

6 local agencies, including the Health Care Financing Ad7 ministration, and with private entities. All Federal, State,

8 and local employees and all private entities are encouraged

9 to provide maximum cooperation to the Task Force.

10 SEC. 10. APPLICATION OF CERTAIN PROVISIONS OF THE

11 BANKRUPTCY CODE.

12 (a) RESTRICTED APPLICABILITY OF BANKRUPTCY

13 STAY, DISCHARGE, AND PREFERENTIAL TRANSFER PRO14 VISIONS TO CERTAIN MEDICARE DEBTS.—Title XI of the

15 Social Security Act (42 U.S.C. 1301 et seq.) is amended

16 by inserting after section 1143 the following:

17 ‘‘APPLICATION OF CERTAIN PROVISIONS OF THE

18 BANKRUPTCY CODE

19 ‘‘SEC. 1144. (a) CERTAIN MEDICARE ACTIONS NOT

20 STAYED BY BANKRUPTCY PROCEEDINGS.—The com21 mencement or continuation of any action against a debtor

22 (as defined in subsection (d)) under this title or title

23 XVIII, including any action or proceeding to exclude or

24 suspend such debtor from program participation, assess

25 civil monetary penalties, recoup or set off overpayments,

26 or deny or suspend payment of claims shall not be subject
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1 to a stay under section 362(a) of title 11, United States

2 Code.

3 ‘‘(b) CERTAIN MEDICARE DEBT NOT DISCHARGE4 ABLE IN BANKRUPTCY.—A debt owed to the United

5 States or to a State by a debtor for an overpayment under

6 title XVIII, or for a penalty, fine, or assessment under

7 this title or title XVIII, shall not be dischargeable under

8 any provision of title 11, United States Code.

9 ‘‘(c) REPAYMENT OF CERTAIN DEBTS CONSIDERED

10 FINAL.—Payments made to repay a debt to the United

11 States or to a State by a debtor with respect to items and

12 services provided, or claims for payment made for such

13 items and services, under title XVIII (including repayment

14 of an overpayment), or to pay a penalty, fine, or assess15 ment under this title or title XVIII, shall be considered

16 final and not avoidable transfers under section 547 of title

17 11, United States Code.

18 ‘‘(d) DEBTOR DEFINED.—In this section, the term

19 ‘debtor’ means a provider of services (as defined in section

20 1861(u)) that has commenced a case under title 11,

21 United States Code.’’.

22 (b) MEDICARE RULES APPLICABLE TO BANKRUPTCY

23 PROCEEDINGS OF A MEDICARE PROVIDER OF SERV24 ICES.—Title XVIII of the Social Security Act (42 U.S.C.

25 1395 et seq.) (as amended by section 4015 of the Bal-
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1 anced Budget Act of 1997) is amended by adding at the

2 end the following:

3 ‘‘APPLICATION OF PROVISIONS OF THE BANKRUPTCY

4 CODE

5 ‘‘SEC. 1897. (a) USE OF MEDICARE STANDARDS AND

6 PROCEDURES.—Notwithstanding any provision of title 11,

7 United States Code, or any other provision of law, in the

8 case of claims by a debtor (as defined in section 1144(d))

9 for payment under this title, the determination of whether

10 the claim is allowable, and of the amount payable, shall

11 be made in accordance with the provisions of this title,

12 title XI, and implementing regulations.

13 ‘‘(b) NOTICE TO CREDITOR OF BANKRUPTCY PETI14 TIONER.—In the case of a debt owed by a debtor (as so

15 defined) to the United States with respect to items and

16 services provided, or claims for payment made, under this

17 title (including a debt arising from an overpayment or a

18 penalty, fine, or assessment under title XI or this title),

19 the notices to the creditor of bankruptcy petitions, pro20 ceedings, and relief required under title 11, United States

21 Code (including under section 342 of that title and rule

22 2002(j) of the Federal Rules of Bankruptcy Procedure),

23 shall be given to the Secretary. Provision of such notice

24 to a fiscal agent of the Secretary shall not be considered

25 to satisfy this requirement.
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1 ‘‘(c) TURNOVER OF PROPERTY TO THE BANKRUPTCY

2 ESTATE.—For purposes of section 542(b) of title 11,

3 United States Code, a claim for payment under this title

4 shall not be considered to be a matured debt payable to

5 the estate of a debtor (as so defined) until such claim has

6 been allowed by the Secretary in accordance with proce7 dures established under this title.’’.

8 SEC. 11. STUDY AND REPORT TO CONGRESS.

9 (a) STUDY.—

10 (1) IN GENERAL.—The Secretary of Health and

11 Human Services (in this section referred to as the

12 ‘‘Secretary’’) shall conduct a study on all matters re13 lating to the appropriate home health services to be

14 provided under the medicare program under title

15 XVIII of the Social Security Act (42 U.S.C. 1395 et

16 seq.) to individuals with chronic conditions.

17 (2) MATTERS STUDIED.—The matters studied

18 by the Secretary shall include—

19 (A) methods to strengthen the role of a

20 physician in developing a plan of care for a ben21 eficiary receiving home health benefits under

22 this title; and

23 (B) the need for an individual or entity

24 (other than the home health agency or the

25 beneficiary’s physician) to have responsibility
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1 for approving the type and quantity of home

2 health services provided to the beneficiary.

3 (b) REPORT.—Not later than 1 year after the date

4 of enactment of this Act, the Secretary shall submit a re5 port to Congress on the study conducted under subsection

6 (a). The Secretary shall include in the report such rec7 ommendations regarding the utilization of home health

8 services under the medicare program as the Secretary de9 termines to be appropriate.

10 SEC. 12. EFFECTIVE DATE.

11 Except as otherwise provided in this Act, the amend12 ments made by this Act shall take effect on the expiration

13 of the date that is 180 calendar days after the date of

14 enactment of this Act.

Æ