I 

111TH CONGRESS 

2D SESSION H. R. 5803 

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

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

IN THE HOUSE OF REPRESENTATIVES 

JULY 21, 2010 

Mr. MCGOVERN (for himself and Mr. JONES) 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 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 2010’’. 


tjames on DSKG8SOYB1PROD with BILLS
2 

•HR 5803 IH

1 SEC. 2. PROTECTING ACCESS TO MEDICARE HOME HEALTH 

2 SERVICES. 

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

4 U.S.C. 1395fff(b)(3)(B)), as amended by section 3401(e) 

5 of the Patient Protection and Affordable Care Act, is 

6 amended— 

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

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

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

10 clause: 

11 ‘‘(vii) SPECIAL RULES FOR CASE MIX

12 CHANGES FOR 2011 AND LATER.— 

13 ‘‘(I) IN GENERAL.—The adjust14 ment under clause (iv) shall only be 

15 made for years beginning with 2011 

16 using standards developed by the Sec17 retary consistent with the processes 

18 described in subclause (II) taking into 

19 account the criteria described in sub20 clause (III). 

21 ‘‘(II) PROCESSES AND CRITERIA

22 FOR EVALUATING CHANGES IN CASE

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

24 the processes described in this sub25 clause are the following: 


tjames on DSKG8SOYB1PROD with BILLS
3 

•HR 5803 IH

1 ‘‘(aa) In developing stand2 ards referred to in such sub3 clause, the Secretary shall con4 vene a Technical Advisory Group 

5 consisting of stakeholders, includ6 ing individuals and organizations 

7 representing the interests of 

8 Medicare beneficiaries, the home 

9 health community, health care 

10 academia, and health care profes11 sionals, in equal numbers from 

12 each and limited to parties with13 out an existing contractual rela14 tionship with the Secretary, to 

15 advise the Secretary concerning 

16 the establishment of such stand17 ards in order to distinguish be18 tween real changes in case mix 

19 and changes in coding or classi20 fication of different units of serv21 ices that do not reflect real 

22 changes in case mix. The Tech23 nical Advisory Group shall be 

24 given the opportunity to review 

25 and comment on any proposed 


tjames on DSKG8SOYB1PROD with BILLS
4 

•HR 5803 IH

1 rulemaking or final determina2 tion by the Secretary on such 

3 standards prior to such rule4 making or determination. 

5 ‘‘(bb) If the Secretary en6 gages an outside contractor to 

7 participate in the evaluation of 

8 case mix changes described in 

9 item (aa), the Secretary shall 

10 only utilize a contractor that has 

11 not previously participated in the 

12 design and establishment of the 

13 case mix adjustment factors 

14 under this subparagraph. 

15 ‘‘(cc) If the Secretary deter16 mines that any increase in case 

17 mix relates to changes in the vol18 ume or nature of services pro19 vided to home health services pa20 tients, the Secretary shall evalu21 ate such increase through actual 

22 review of claims and services and 

23 shall not use any proxy or surro24 gate for determining whether the 

25 change in volume or nature of 


tjames on DSKG8SOYB1PROD with BILLS
5 

•HR 5803 IH

1 services is reasonable and nec2 essary. 

3 ‘‘(dd) The Secretary shall 

4 establish the standards referred 

5 to in item (aa) by regulation. 

6 ‘‘(ee) With respect to estab7 lishment of such standards, the 

8 Secretary shall make public all 

9 data, reports, and supporting 

10 materials, including any com11 ments by the Technical Advisory 

12 Group pursuant to item (aa), re13 garding the standards at the time 

14 of notice of such standards. 

15 ‘‘(III) CRITERIA.—The criteria 

16 described in this subclause are the fol17 lowing: 

18 ‘‘(aa) The impact of changes 

19 in the program under this title 

20 that may affect the characteris21 tics of individuals receiving home 

22 health services. 

23 ‘‘(bb) The impact of changes 

24 in the provision of health care 


tjames on DSKG8SOYB1PROD with BILLS
6 

•HR 5803 IH

1 services by providers of services 

2 other than home health agencies. 

3 ‘‘(cc) Distinctions in the 

4 characteristics of individuals ini5 tiating home health services from 

6 the community and institutional 

7 care settings. 

8 ‘‘(dd) Whether any changes 

9 in coding resulted in a change in 

10 expenditures overall annually and 

11 disregarding changes in coding 

12 that do not have an overall ex13 penditure impact. 

14 ‘‘(ee) Any other factors de15 termined appropriate by the Sec16 retary in consultation with the 

17 Technical Advisory Group under 

18 subclause (II)(aa).’’. 

Æ 


tjames on DSKG8SOYB1PROD with BILLS