I 

113TH CONGRESS 

2D SESSION H. R. 5110 

To amend title XVIII of the Social Security Act to repeal rebasing of payments for home health services, as required under the Patient Protection 

and Affordable Care Act, and to replace such rebasing with a Medicare 

home health value-based purchasing program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 15, 2014 

Mr. WALDEN (for himself, Mr. PRICE of Georgia, Mrs. ELLMERS, Mr. MCKINLEY, Mr. LATHAM, Mr. DUFFY, Mrs. MCMORRIS RODGERS, Mr. GRAVES

of Missouri, Mr. BOUSTANY, Mr. PAULSEN, Mr. THOMPSON of Pennsylvania, Mr. YOUNG of Alaska, and Mr. GARDNER) 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 repeal 

rebasing of payments for home health services, as required under the Patient Protection and Affordable Care 

Act, and to replace such rebasing with a Medicare home 

health value-based purchasing program, 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, 


tjames on DSK5VPTVN1PROD with BILLS
2 

•HR 5110 IH

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Securing Access Via 

3 Excellence for Medicare Home Health Act of 2014’’ or the 

4 ‘‘SAVE Medicare Home Health Act of 2014’’. 

5 SEC. 2. REPEAL OF MEDICARE HOME HEALTH REBASING 

6 REDUCTION PROVIDED UNDER PPACA AND 

7 DETAILED ANALYSIS OF SUCH REDUCTION. 

8 (a) REPEAL OF REBASING REDUCTION AND CODI9 FICATION OF CY 2014 PAYMENT ADJUSTMENT.— 

10 (1) REPEAL.—Section 1895(b)(3)(A) of the So11 cial Security Act (42 U.S.C. 1395fff(b)(3)(A)) is 

12 amended by striking clause (iii). 

13 (2) CODIFICATION.—Such section, as amended 

14 by paragraph (1), is further amended by adding at 

15 the end the following new clause: 

16 ‘‘(iii) CODIFICATION OF CY 2014 PAY17 MENT ADJUSTMENT.—The amount (or 

18 amounts) that would otherwise be applica19 ble under clause (i)(III) for 2015 and sub20 sequent years shall be determined taking 

21 into account the 3.5 percentage point re22 duction effective for 2014 pursuant to the 

23 rule for home health prospective payment 

24 system rate update for calendar year 2014 

25 (promulgated on December 2, 2013, 78 

26 Federal Register 72256).’’. 


tjames on DSK5VPTVN1PROD with BILLS
3 

•HR 5110 IH

1 (b) DETAILED ANALYSIS OF REBASING REDUC2 TION.— 

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

4 Human Services shall conduct a detailed analysis of 

5 the rebasing reduction in Medicare payments for 

6 home health services promulgated under the rule for 

7 home health prospective payment system rate update 

8 for calendar year 2014 (promulgated on December 

9 2, 2013, 78 Federal Register 72256), pursuant to 

10 the Regulatory Flexibility Act, Executive Order 

11 13563, section 3131(a) of the Patient Protection 

12 and Affordable Care Act, and other specified factors. 

13 Such analysis shall include an assessment of at least 

14 the following factors: 

15 (A) The age, poverty level, gender, rural 

16 residence, ethnic or racial minority, and infir17 mity of Medicare beneficiaries receiving home 

18 health services in comparison to other Medicare 

19 beneficiaries. 

20 (B) The number, gender, and geographic 

21 distribution of professional Medicare home 

22 health caregivers. 

23 (C) The number and location of home 

24 health agencies that have closed, consolidated, 


tjames on DSK5VPTVN1PROD with BILLS
4 

•HR 5110 IH

1 or been acquired since the rebasing reduction 

2 was implemented. 

3 (D) The number and location of profes4 sional home health caregiver jobs that have 

5 been lost since the rebasing reduction was im6 plemented. 

7 (2) REPORT.—Not later than February 1, 

8 2015, the Secretary shall submit to Congress a re9 port that contains findings regarding the analysis 

10 conducted under paragraph (1), including the Sec11 retary’s assessment of the factors specified in such 

12 paragraph. 

13 SEC. 3. ESTABLISHMENT OF HOME HEALTH VALUE-BASED 

14 PURCHASING (VBP) PROGRAM. 

15 (a) READMISSION MEASURES.—Section 1895 of the 

16 Social Security Act (42 U.S.C. 1395fff) is amended by 

17 adding at the end the following new subsection: 

18 ‘‘(f) POST-HOSPITAL HOME HEALTH SERVICES RE19 ADMISSION MEASURE.— 

20 ‘‘(1) READMISSION MEASURE.—Not later than 

21 January 1, 2016, the Secretary shall specify a home 

22 health all-cause all-condition hospital unplanned re23 admission measure (or any successor to such a 

24 measure) for readmissions (for any cause) to a hos25 pital for an individual who is entitled to benefits 


tjames on DSK5VPTVN1PROD with BILLS
5 

•HR 5110 IH

1 under part A (or enrolled under part B) and who is 

2 receiving post-hospital home health services. 

3 ‘‘(2) RESOURCE USE MEASURE.—Not later than 

4 January 1, 2017, the Secretary shall specify a meas5 ure that is the measure specified under paragraph 

6 (1), risk-adjusted for potentially preventable re7 admissions to a hospital for an individual described 

8 in such paragraph. 

9 ‘‘(3) DEVELOPMENT.—The measures specified 

10 under paragraphs (1) and (2) shall be developed 

11 through a formal process that is based on input 

12 from a group of multiple stakeholders consisting of 

13 at least senior advocates, Medicare beneficiaries, 

14 caregivers, and home health physicians, nurses, 

15 therapists, and operators of home health agencies. 

16 ‘‘(4) QUARTERLY FEEDBACK REPORTS TO

17 HOME HEALTH AGENCIES.—Beginning January 1, 

18 2017, and every quarter thereafter, the Secretary 

19 shall provide confidential feedback to home health 

20 agencies on their performance with respect to such 

21 measures. 

22 ‘‘(5) PUBLIC REPORTING ON PERFORMANCE.— 

23 ‘‘(A) IN GENERAL.—Subject to subpara24 graphs (B) and (C), the Secretary shall estab25 lish procedures for making public on the MediVerDate Mar 15 2010 03:04 Jul 18, 2014 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5110.IH H5110

tjames on DSK5VPTVN1PROD with BILLS
6 

•HR 5110 IH

1 care Home Health Compare website (or suc2 cessor to such website) the performance of 

3 home health agencies with respect to a measure 

4 specified under paragraph (1) and a measure 

5 specified under paragraph (2). 

6 ‘‘(B) OPPORTUNITY TO REVIEW.—The pro7 cedures under subparagraph (A) shall ensure 

8 that a home health agency has the opportunity 

9 to review and submit corrections to the infor10 mation that is to be made public with respect 

11 to such agency before such information is made 

12 public. 

13 ‘‘(C) TIMING.—Such procedures shall pro14 vide that the information described in subpara15 graph (A) is first made publicly available begin16 ning no later than January 1, 2018.’’. 

17 (b) VALUE-BASED PURCHASING PROGRAM FOR

18 HOME HEALTH AGENCIES.—Section 1895 of the Social 

19 Security Act (42 U.S.C. 1395fff), as amended by sub20 section (a), is further amended by adding at the end the 

21 following new subsection: 

22 ‘‘(g) APPLICATION OF VALUE-BASED PURCHASING

23 PROGRAM.— 

24 ‘‘(1) ESTABLISHMENT.— 


tjames on DSK5VPTVN1PROD with BILLS
7 

•HR 5110 IH

1 ‘‘(A) IN GENERAL.—Subject to the suc2 ceeding provisions of this subsection, the Sec3 retary shall establish a home health agency 

4 value-based purchasing program (in this sub5 section referred to as the ‘HHA VBP Pro6 gram’) under which value-based incentive pay7 ments are made in a year to home health agen8 cies. 

9 ‘‘(B) PROGRAM TO BEGIN IN 2019.—The 

10 HHA VBP Program shall apply to payments 

11 for episodes of home health services beginning 

12 on or after January 1, 2019. 

13 ‘‘(2) APPLICATION OF MEASURES.—— 

14 ‘‘(A) IN GENERAL.—Subject to subpara15 graph (B), the Secretary shall apply the meas16 ure specified under subsection (f)(2) for pur17 poses of the HHA VBP Program. 

18 ‘‘(B) REPLACEMENT.—If the Secretary de19 termines that the application of such measure is 

20 not practicable and should be delayed and the 

21 Secretary notifies the Committee on Finance of 

22 the Senate and the Committees on Ways and 

23 Means and Energy and Commerce of the House 

24 of Representatives of the reasons for such delay 

25 in advance of implementing such delay, the SecVerDate Mar 15 2010 03:04 Jul 18, 2014 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5110.IH H5110

tjames on DSK5VPTVN1PROD with BILLS
8 

•HR 5110 IH

1 retary may delay the application of such meas2 ure for a period of up to 1 year. For the period 

3 of any such delay, the measure specified under 

4 subsection (f)(1) shall apply for purposes of the 

5 HHA VBP Program instead of the measure 

6 specified under subsection (f)(2). 

7 ‘‘(3) PERFORMANCE STANDARDS.— 

8 ‘‘(A) ESTABLISHMENT.—The Secretary 

9 shall establish performance standards with re10 spect to the measure applied under paragraph 

11 (2) for a performance period for a year. 

12 ‘‘(B) HIGHER OF ACHIEVEMENT AND IM13 PROVEMENT.—The performance standards es14 tablished under subparagraph (A) shall include 

15 levels of achievement and improvement. In cal16 culating the HHA performance score under 

17 paragraph (4), the Secretary shall use the high18 er of either improvement or achievement. 

19 ‘‘(C) TIMING.—The Secretary shall estab20 lish and announce the performance standards 

21 established under subparagraph (A) not later 

22 than 60 days before the beginning of the per23 formance period for the year involved. 

24 ‘‘(4) HHA PERFORMANCE SCORE.— 


tjames on DSK5VPTVN1PROD with BILLS
9 

•HR 5110 IH

1 ‘‘(A) IN GENERAL.—The Secretary shall 

2 develop by regulation a methodology for assess3 ing the total performance of each home health 

4 agency based on performance standards estab5 lished under paragraph (3) with respect to the 

6 measure applied under paragraph (2). Using 

7 such methodology, the Secretary shall provide 

8 for an assessment (in this subsection referred to 

9 as the ‘HHA performance score’) for each home 

10 health agency for each such performance pe11 riod. 

12 ‘‘(B) RANKING OF HHA PERFORMANCE

13 SCORES.—The Secretary shall, for the perform14 ance period for each year, rank the HHA per15 formance scores determined under subpara16 graph (A) from low to high. 

17 ‘‘(5) BUDGET NEUTRAL WITHHOLDING.—The 

18 Secretary shall withhold from the payment rates 

19 made for each year (during the period beginning 

20 with 2019 and ending with 2024) for home health 

21 services under this section such withholding percent22 age as is necessary so that the enactment of the Se23 curing Access Via Excellence for Medicare Home 

24 Health Act of 2014 is estimated not to result in any 


tjames on DSK5VPTVN1PROD with BILLS
10 

•HR 5110 IH

1 net change in payments made for such services 

2 under this title. 

3 ‘‘(6) VALUE-BASED INCENTIVE PAYMENT PER4 CENTAGE.—The Secretary shall provide for a dis5 tribution of a portion of the amounts withheld under 

6 paragraph (5) for performance payments to home 

7 health agencies in a manner so as to ensure that— 

8 ‘‘(A) the distribution (expressed as a per9 centage of such withheld amounts) is based on 

10 each agency’s HHA performance ranking under 

11 paragraph (4)(B) for the performance period 

12 for the year involved; 

13 ‘‘(B) the application of all such percent14 ages in such year results in an appropriate dis15 tribution of value-based incentive payments 

16 under this subsection such that— 

17 ‘‘(i) home health agencies with the 

18 highest rankings under paragraph (4)(B) 

19 receive the highest value-based incentive 

20 payment amounts under this subsection; 

21 ‘‘(ii) home health agencies with the 

22 lowest rankings under paragraph (4)(B) 

23 receive the lowest value-based incentive 

24 payment amounts under this subsection; 

25 and 


tjames on DSK5VPTVN1PROD with BILLS
11 

•HR 5110 IH

1 ‘‘(iii) in the case of home health agen2 cies in the lowest 40 percent of the ranking 

3 under paragraph (4)(B), the payment rate 

4 under this subsection for services furnished 

5 by such facility during such year shall be 

6 less than the payment rate for such serv7 ices for such year that would otherwise 

8 apply without application of this sub9 section; and 

10 ‘‘(C) the total amount of value-based in11 centive payments under this subsection for all 

12 home health agencies in such year shall be 

13 greater than or equal to 50 percent, but not 

14 greater than 70 percent, of the total amount of 

15 the payments withheld for such year under 

16 paragraph (5), as estimated by the Secretary. 

17 ‘‘(7) ANNOUNCEMENT OF RESULT OF ADJUST18 MENTS.—Under the HHA VBP program, the Sec19 retary shall, not later than 60 days before a year in20 volved, inform each home health agency of the ad21 justments to payments to the agency for services 

22 furnished by the agency during the year under this 

23 subsection. 

24 ‘‘(8) NO EFFECT IN SUBSEQUENT YEAR.—The 

25 value-based payment adjustments under this subVerDate Mar 15 2010 03:04 Jul 18, 2014 Jkt 039200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H5110.IH H5110

tjames on DSK5VPTVN1PROD with BILLS
12 

•HR 5110 IH

1 section shall only apply with respect to the year in2 volved, and the Secretary shall not take into account 

3 such adjustment in making payments to a home 

4 health agency under this section in a subsequent 

5 year. 

6 ‘‘(9) FUNDING FOR PROGRAM MANAGEMENT.— 

7 The Secretary shall provide for the one-time transfer 

8 from the Federal Supplementary Medical Insurance 

9 Trust Fund established under section 1841 to the 

10 Centers for Medicare & Medicaid Services Program 

11 Management Account of— 

12 ‘‘(A) $2,000,000 for purposes of subsection 

13 (f); and 

14 ‘‘(B) $10,000,000 for purposes of imple15 menting this subsection. 

16 Such funds shall remain available until expended.’’. 

17 (c) MEDPAC STUDY.—Not later than June 30, 

18 2021, the Medicare Payment Advisory Commission shall 

19 submit to Congress a report that reviews the progress of 

20 the home health value-based purchasing program estab21 lished under section 1895(g) of the Social Security Act, 

22 as added by subsection (b), and makes recommendations, 

23 as appropriate, on any improvements that should be made 

24 to such program. For purposes of the previous sentence, 

25 the Medicare Payment Advisory Commission shall conVerDate Mar 15 2010 03:04 Jul 18, 2014 Jkt 039200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H5110.IH H5110

tjames on DSK5VPTVN1PROD with BILLS
13 

•HR 5110 IH

1 sider any unintended consequences with respect to such 

2 home health agency value-based purchasing program and 

3 any potential adjustments to the readmission measure 

4 specified under section 1895(f) of such Act, as added by 

5 subsection (a), for purposes of determining the effect of 

6 the socio-economic status of a beneficiary under the Medi7 care program under title XVIII of the Social Security Act 

8 on the performance score of a home health agency pro9 vided under section 1895(g)(4) of such Act, as added by 

10 subsection (b). 

Æ 


tjames on DSK5VPTVN1PROD with BILLS