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106TH CONGRESS

1ST SESSION S. 1574

To amend title XVIII of the Social Security Act to improve the interim

payment system for home health services, and for other purposes.

IN THE SENATE OF THE UNITED STATES

SEPTEMBER 10, 1999

Mr. CONRAD (for himself, Mr. FEINGOLD, and Mr. CHAFEE) 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 improve

the interim payment system for home health services,

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,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘The Fairness in Medi5 care Home Health Access Act of 1999’’.

6 SEC. 2. FINDINGS AND PURPOSES.

7 (a) FINDINGS.—Congress finds the following:

8 (1) Home health care is a vital component of

9 the medicare program under title XVIII of the So10 cial Security Act.
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1 (2) Home health services provided under the

2 medicare program enable medicare beneficiaries who

3 are homebound and greatly risk costly institutional4 ized care to continue to live in their own homes and

5 communities.

6 (3) Implementation of the interim payment sys7 tem for home health services has inadvertently exac8 erbated payment disparities for home health services

9 among regions, penalizing efficient, low-cost pro10 viders in rural areas and providing insufficient com11 pensation for the care of medicare beneficiaries with

12 acute, medically complex conditions.

13 (4) The combination of insufficient payments

14 and new administrative changes has reduced the ac15 cess of medicare beneficiaries to home health serv16 ices in many areas by forcing home health agencies

17 to provide fewer services, to shrink their service

18 areas, or to limit the types of conditions for which

19 they provide treatment.

20 (b) PURPOSES.—The purposes of this Act are as fol21 lows:

22 (1) To improve access to care for medicare

23 beneficiaries with high medical needs by establishing

24 a process for home health agencies to exclude serv25 ices provided to medicare beneficiaries with acute,
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1 medically complex conditions from payment limits

2 and to receive payment based on the reasonable

3 costs of providing such services through a process

4 that is feasible for the Health Care Financing Ad5 ministration to administer.

6 (2) To ensure that the 15 percent contingency

7 reduction in medicare payments for home health

8 services established under the Balanced Budget Act

9 of 1997 does not occur under the interim payment

10 system for home health services.

11 (3) To reduce the scheduled 15 percent reduc12 tion in the cost limits and per beneficiary limits to

13 10 percent and to phase-in the additional 5 percent

14 reduction in such limits after the initial 3 years of

15 the prospective payment system for home health

16 services.

17 (4) To address the unique challenges of serving

18 medicare beneficiaries in rural and underserved

19 areas by increasing the per visit cost limit under the

20 interim payment system for home health services.

21 (5) To refine the home health consolidated bill22 ing provision to ensure that medicare beneficiaries

23 requiring durable medical equipment services do not

24 experience a break in the continuum of care during

25 episodes of home health care.
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1 (6) To eliminate the requirement that home

2 health agencies identify the length of time of a serv3 ice visit in 15 minute increments.

4 (7) To express the sense of the Senate that the

5 Secretary of Health and Human Services should es6 tablish a uniform process for disseminating informa7 tion to fiscal intermediaries to ensure timely and ac8 curate information to home health agencies and

9 beneficiaries.

10 SEC. 3. ADEQUATELY ACCOUNTING FOR THE NEEDS OF

11 MEDICARE BENEFICIARIES WITH ACUTE,

12 MEDICALLY COMPLEX CONDITIONS.

13 (a) WAIVER OF PER BENEFICIARY LIMITS FOR

14 OUTLIERS.—Section 1861(v)(1)(L) of the Social Security

15 Act (42 U.S.C. 1395x(v)(1)(L)), as amended by section

16 5101 of the Tax and Trade Relief Extension Act of 1998

17 (contained in Division J of Public Law 105–277), is

18 amended—

19 (1) by redesignating clause (ix) as clause (x);

20 and

21 (2) by inserting after clause (viii) the following:

22 ‘‘(ix)(I) Notwithstanding the applicable per bene23 ficiary limit under clause (v), (vi), or (viii), but subject

24 to the applicable per visit limit under clause (i), in the

25 case of a provider that demonstrates to the Secretary that
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1 with respect to an individual to whom the provider fur2 nished home health services appropriate to the individual’s

3 condition (as determined by the Secretary) at a reasonable

4 cost (as determined by the Secretary), and that such rea5 sonable cost significantly exceeded such applicable per

6 beneficiary limit because of unusual variations in the type

7 or amount of medically necessary care required to treat

8 the individual, the Secretary, upon application by the pro9 vider, shall pay to such provider for such individual such

10 reasonable cost.

11 ‘‘(II) The total amount of the additional payments

12 made to home health agencies pursuant to subclause (I)

13 in any fiscal year shall not exceed an amount equal to 2

14 percent of the amounts that would have been paid under

15 this subparagraph in such year if this clause had not been

16 enacted.’’.

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

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

19 of this Act, and apply with respect to each application for

20 payment of reasonable costs for outliers submitted by any

21 home health agency for cost reporting periods ending on

22 or after October 1, 1999.
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1 SEC. 4. PROTECTION OF THE ACCESS OF MEDICARE BENE2 FICIARIES TO HOME HEALTH SERVICES BY

3 ADDRESSING THE 15 PERCENT CONTIN4 GENCY REDUCTION IN INTERIM PAYMENTS

5 FOR HOME HEALTH SERVICES.

6 (a) ELIMINATION OF CONTINGENCY REDUCTION.—

7 Section 4603 of the Balanced Budget Act of 1997 (42

8 U.S.C. 1395fff note), as amended by section 5101(c)(3)

9 of the Tax and Trade Relief Extension Act of 1998 (con10 tained in division J of Public Law 105–277), is amended

11 by striking subsection (e).

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

13 subsection (a) shall take effect as if included in the enact14 ment of the Balanced Budget Act of 1997 (Public Law

15 105–33; 111 Stat. 251).

16 SEC. 5. PROTECTION OF THE ACCESS OF MEDICARE BENE17 FICIARIES TO HOME HEALTH SERVICES

18 THROUGH A PHASE-IN OF THE 15 PERCENT

19 REDUCTION IN PROSPECTIVE PAYMENTS

20 FOR HOME HEALTH SERVICES.

21 (a) PHASE-IN OF 15 PERCENT REDUCTION.—Section

22 1895(b)(3)(A)(ii) (42 U.S.C. 1395fff(b)), as amended by

23 section 5101(c)(1)(B) of the Tax and Trade Relief Exten24 sion Act of 1998 (contained in division J of Public Law

25 105–277), is amended—
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1 (1) in paragraph (3)(A)(ii), by striking ‘‘15’’

2 and inserting ‘‘10’’; and

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

4 ‘‘(7) SPECIAL RULE FOR PAYMENTS BEGINNING

5 WITH FISCAL YEAR 2004.—Beginning with fiscal year

6 2004, payment under this section shall be made as

7 if ‘15’ had been substituted for ‘10’ in clause (ii) of

8 paragraph (3)(A) when computing the initial basis

9 under such paragraph.’’.

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

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

12 of this Act.

13 SEC. 6. INCREASE IN PER VISIT COST LIMIT TO 112 PER14 CENT OF THE NATIONAL MEDIAN.

15 Section 1861(v)(1)(L)(i) of the Social Security Act

16 (42 U.S.C. 1395x(v)(1)(L)(i)), as amended by section

17 5101(b) of the Tax and Trade Relief Extension Act of

18 1998 (contained in division J of Public Law 105–277),

19 is amended—

20 (1) in subclause (IV), by striking ‘‘or’’;

21 (2) in subclause (V)—

22 (A) by inserting ‘‘and before October 1,

23 1999,’’ after ‘‘October 1, 1998,’’; and

24 (B) by striking the period and inserting ‘‘,

25 or’’; and
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1 (3) by adding at the end the following:

2 ‘‘(VI) October 1, 1999, 112 percent of such me3 dian.’’.

4 SEC. 7. REFINEMENT OF HOME HEALTH AGENCY CONSOLI5 DATED BILLING.

6 (a) IN GENERAL.—Section 1842(b)(6)(F) of the So7 cial Security Act (42 U.S.C. 1395u(b)(6)(F)) is amended

8 by inserting ‘‘(including medical supplies described in sec9 tion 1861(m)(5), but excluding durable medical equipment

10 described in such section)’’ after ‘‘home health services’’.

11 (b) CONFORMING AMENDMENT.—Section

12 1862(a)(21) of the Social Security Act (42 U.S.C.

13 1395y(a)(21)) is amended by inserting ‘‘(including med14 ical supplies described in section 1861(m)(5), but exclud15 ing durable medical equipment described in such section)’’

16 after ‘‘home health services’’.

17 (c) EFFECTIVE DATE.—The amendments made by

18 this section shall take effect as if included in the amend19 ments made by section 4603 of the Balanced Budget Act

20 of 1997 (Public Law 105–33; 111 Stat. 467).

21 SEC. 8. ELIMINATION OF TIMEKEEPING REQUIREMENTS

22 UNDER THE PROSPECTIVE PAYMENT SYSTEM

23 FOR HOME HEALTH AGENCIES.

24 (a) IN GENERAL.—Section 1895(c) of the Social Se25 curity Act (42 U.S.C. 1395fff(c)) is amended—
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1 (1) by striking ‘‘unless—’’ and all that follows

2 through ‘‘(1) the’’ and inserting ‘‘unless the’’; and

3 (2) by striking ‘‘1835(a)(2)(A);’’ and all that

4 follows through the period and inserting

5 ‘‘1835(a)(2)(A).’’.

6 (b) EFFECTIVE DATE.—The amendments made by

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

8 of this Act.

9 SEC. 9. SENSE OF THE SENATE REGARDING THE TIMELI10 NESS AND ACCURACY OF INTERMEDIARY

11 COMMUNICATIONS TO HOME HEALTH AGEN12 CIES.

13 It is the sense of the Senate that the Secretary of

14 Health and Human Services should establish a nationally

15 uniform process that ensures that each fiscal intermediary

16 (as defined in section 1816(a) of the Social Security Act

17 (42 U.S.C. 1395h(a))) and each carrier (as defined in sec18 tion 1842(f) of such Act (42 U.S.C. 1395u(f))) has the

19 training and ability necessary to provide timely, accurate,

20 and consistent coverage and payment information to each

21 home health agency and to each individual eligible to have

22 payment made under the medicare program under title

23 XVIII of such Act (42 U.S.C. 1395 et seq.).

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