I

106TH CONGRESS

1ST SESSION H. R. 1917

To direct the Secretary of Health and Human Services to make additional

payments under the Medicare Program to certain home health agencies

with high-cost patients, to provide for an interest-free grace period for

the repayment of overpayments made by the Secretary to home health

agencies, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

MAY 25, 1999

Mr. MCGOVERN (for himself, Mr. COBURN, Mr. WEYGAND, Mr. BARTON of

Texas, Mr. MCINTOSH, Mr. RAHALL, Mr. HILLEARY, Ms. HOOLEY of Oregon, Mr. WAMP, and Mr. ACKERMAN) introduced the following bill;

which was referred to the Committee on Ways and Means, and in addition to the Committee on 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 direct the Secretary of Health and Human Services to

make additional payments under the Medicare Program

to certain home health agencies with high-cost patients,

to provide for an interest-free grace period for the repayment of overpayments made by the Secretary to home

health agencies, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Home Health Access

3 Preservation Act of 1999’’.

4 SEC. 2. ADDITIONAL PAYMENTS TO AGENCIES FOR MOST

5 EXPENSIVE CASES.

6 (a) PAYMENTS FOR OUTLIERS.—

7 (1) IN GENERAL.—Subject to paragraph (2),

8 from amounts appropriated pursuant to subsection

9 (e), the Secretary of Health and Human Services

10 shall pay an additional amount to home health agen11 cies furnishing qualified home health services during

12 a cost reporting period beginning on or after Octo13 ber 1, 1997, under the medicare program (under

14 title XVIII of the Social Security Act).

15 (2) LIMITATION OF PAYMENTS.—No payment

16 shall be made under this section to a home health

17 agency that, as of the date of the enactment of this

18 Act, has ceased furnishing home health services for

19 which payment may be made under the medicare

20 program (under such title).

21 (b) DESCRIPTION OF QUALIFIED SERVICES.—For

22 purposes of additional payment amounts under this sec23 tion by the Secretary to home health agencies, qualified

24 home health services are home health services furnished

25 under the medicare program for the treatment of condi26 tions within a diagnosis described in subsection (c).
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1 (c) DESCRIPTION OF DIAGNOSIS.—A diagnosis de2 scribed in this subsection is one of the following diagnoses

3 as classified in St. Anthony’s ICD–9–CM Code Book for

4 Physician Payment:

5 (1) diabetes mellitus (ICD–9–CM code 250).

6 (2) essential hypertension (ICD–9–CM code

7 401).

8 (3) other forms of chronic ischemic heart dis9 ease (ICD–9–CM code 414).

10 (4) heart failure (ICD–9–CM code 428).

11 (5) acute, but ill-defined cerebrovascular disease

12 (ICD–9–CM code 436).

13 (6) pneumonia, organism unspecified (ICD–9–

14 CM code 486).

15 (7) chronic airway obstruction, not elsewhere

16 classified (ICD–9–CM code 496).

17 (8) chronic ulcer of skin (ICD–9–CM code

18 707).

19 (9) symptoms involving urinary system (ICD–

20 9–CM code 788).

21 (10) fracture of neck of femur (ICD–9–CM

22 code 820).

23 (d) DETERMINATION OF AGENCY-SPECIFIC PAY24 MENT AMOUNT.—
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1 (1) CERTIFICATION OF QUANTITY OF QUALI2 FIED HOME HEALTH SERVICES FURNISHED.—

3 (A) IN GENERAL.—With respect to a fiscal

4 year, a home health agency may submit to the

5 Secretary a certification of the number of pa6 tients to whom the agency furnished qualified

7 home health services during the agency’s cost

8 reporting period beginning in that fiscal year.

9 (B) DEADLINE FOR SUBMISSION.—

10 (i) IN GENERAL.—Such certification

11 shall be submitted to the Secretary during

12 the 30-day period beginning on the date

13 the agency submits to the Secretary a cost

14 report for the cost reporting period begin15 ning in such fiscal year.

16 (ii) TRANSITION RULE.—In the case

17 of an agency with a cost reporting period

18 beginning on or after October 1, 1997,

19 that ends before the date of the enactment

20 of this Act, with respect to such cost re21 porting period, the 30-day period under

22 clause (i) begins 60 days after the date of

23 the enactment of this Act.

24 (2) DETERMINATION OF AGGREGATE QUALI25 FIED HOME HEALTH SERVICES FURNISHED.—From
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1 data contained in certifications submitted under

2 paragraph (1) with respect to cost reporting periods

3 beginning in fiscal years 1998, 1999, and 2000, the

4 Secretary shall determine, with respect to a fiscal

5 year, the number of patients who have received

6 qualified home health services furnished by agencies

7 submitting such certifications for that fiscal year.

8 The Secretary shall make such determination by not

9 later than 120 days after all cost reports for that

10 fiscal year have been received.

11 (3) AGENCY-SPECIFIC PERCENTAGE OF AGGRE12 GATE AMOUNT.—For each home health agency sub13 mitting a certification under paragraph (1) for a fis14 cal year described in paragraph (2), the Secretary

15 shall determine an agency-specific percentage by di16 viding the number of patients certified by the home

17 health agency for that fiscal year by the national

18 total specified in paragraph (2) for that fiscal year.

19 (4) PAYMENT AMOUNT.—The Secretary shall

20 pay for a fiscal year described in paragraph (2) to

21 a home health agency making the certification under

22 paragraph (1) an amount equal to the product of the

23 percentage determined under paragraph (3) and the

24 amount appropriated for such fiscal year under sub25 section (e).
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1 (e) AUTHORIZATION OF APPROPRIATIONS.—There is

2 authorized to be appropriated from the Federal Hospital

3 Insurance Trust Fund (established under section 1817 of

4 the Social Security Act (42 U.S.C. 1395i)) for making ad5 ditional payments to home health agencies under this sec6 tion, $250,000,000 in each of the fiscal years 2000

7 through 2002.

8 (f) TERMINATION.—The Secretary shall not make ad9 ditional payments under this section for cost reporting pe10 riods, or portions of cost reporting periods, beginning on

11 or after the date of the implementation of the prospective

12 payment system for home health services under section

13 1895 of the Social Security Act (42 U.S.C. 1395fff).

14 (g) LIMITATION ON JUDICIAL REVIEW.—There shall

15 be no administrative or judicial review under section 1869

16 of the Social Security Act (42 U.S.C. 1395ff), section

17 1878 of such Act (42 U.S.C. 1395oo), or otherwise of any

18 action of the Secretary with respect to the determination

19 of an additional payment amount under this section.

20 SEC. 3. OVERPAYMENTS.

21 (a) 36-MONTH REPAYMENT PERIOD.—In the case of

22 an overpayment by the Secretary of Health and Human

23 Services to a home health agency for home health services

24 furnished during a cost reporting period beginning on or

25 after October 1, 1997, as a result of payment limitations
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1 provided for under clause (v), (vi), or (viii) of section

2 1861(v)(1)(L) of the Social Security Act (42 U.S.C.

3 1395x(v)(1)(L)), the home health agency may elect to

4 repay the amount of such overpayment over a 36-month

5 period beginning on the date of notification of such over6 payment.

7 (b) INTEREST ON OVERPAYMENT AMOUNTS.—

8 (1) 36-MONTH GRACE PERIOD.—

9 (A) IN GENERAL.—In the case of an agen10 cy that makes an election under subsection (a),

11 no interest shall accrue on the outstanding bal12 ance of the amount of overpayment during such

13 36-month period.

14 (B) OVERDUE BALANCES.—In the case of

15 such an agency, interest shall accrue on any

16 outstanding balance of the amount of overpay17 ment after termination of such 36-month pe18 riod. Interest shall accrue under this subpara19 graph at the rate of interest charged by banks

20 for loans to their most favored commercial cus21 tomers, as published in the Wall Street Journal

22 on the Friday immediately following the date of

23 the enactment of this Act.

24 (2) OTHER AGENCIES.—In the case of an agen25 cy described in subsection (a) that does not make an
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1 election under subsection (a), interest shall accrue

2 on the outstanding balance of the amount of over3 payment at the rate described in the second sentence

4 of paragraph (1)(B).

5 (c) TERMINATION.—No election under subsection (a)

6 may be made for cost reporting periods, or portions of cost

7 reporting periods, beginning on or after the date of the

8 implementation of the prospective payment system for

9 home health services under section 1895 of the Social Se10 curity Act (42 U.S.C. 1395fff).

11 (d) EFFECTIVE DATE.—The provisions of subsection

12 (a) shall take effect as if included in the enactment of the

13 Balanced Budget Act of 1997.

14 SEC. 4. UPDATE ON IMPLEMENTATION OF PROSPECTIVE

15 PAYMENT SYSTEM FOR HOME HEALTH AGEN16 CIES.

17 Not later than 90 days after the date of enactment

18 of this Act, and every 90 days thereafter until the prospec19 tive payment system for home health agencies (established

20 by section 1895 of the Social Security Act (42 U.S.C.

21 1395fff)) is implemented, the Secretary of Health and

22 Human Services shall meet with the staff of the appro23 priate committees of Congress to provide an informal up-
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1 date regarding the progress of the Secretary in imple2 menting such payment system.

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