I 

118TH CONGRESS 

1ST SESSION H. R. 5159 

To amend title XVIII of the Social Security Act to ensure stability in 

payments to home health agencies under the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

AUGUST 4, 2023 

Ms. SEWELL (for herself and Mr. SMITH of Nebraska) 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 ensure 

stability in payments to home health agencies 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 ‘‘Preserving Access to 

5 Home Health Act of 2023’’. 


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1 SEC. 2. ENSURING STABILITY IN PAYMENTS TO HOME 

2 HEALTH AGENCIES. 

3 (a) REPEAL OF PERMANENT AND TEMPORARY AD4 JUSTMENTS.—Section 1895(b)(3) of the Social Security 

5 Act (42 U.S.C. 1395fff(b)(3)) is amended by striking sub6 paragraph (D). 

7 (b) EFFECTIVE DATE; IMPLEMENTATION.— 

8 (1) EFFECTIVE DATE.—The amendment made 

9 by subsection (a) shall take effect as if included in 

10 the enactment of the Bipartisan Budget Act of 2018 

11 (Public Law 115–123). 

12 (2) IMPLEMENTATION.—The Secretary of 

13 Health and Human Services (in this section referred 

14 to as the ‘‘Secretary’’) shall implement such section 

15 1895(b)(3) for 2024 and subsequent years as if the 

16 amendment made by section 51001(a)(2)(B) of divi17 sion E of the Bipartisan Budget Act of 2018 (Public 

18 Law 115–123) (adding such subparagraph (D)) had 

19 not been made. 

20 (c) CONSTRUCTION.—Nothing in this section shall be 

21 construed as signifying congressional approval or dis22 approval of the methodology promulgated by the Secretary 

23 to implement section 1895(b)(3)(D) of the Social Security 

24 Act in the final rule entitled, ‘‘Medicare Program; Cal25 endar Year (CY) 2023 Home Health Prospective Payment 

26 System Rate Update; Home Health Quality Reporting 


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1 Program Requirements; Home Health Value-Based Pur2 chasing Expanded Model Requirements; and Home Infu3 sion Therapy Services Requirements’’ published in the 

4 Federal Register on November 4, 2022 (87 Fed. Reg. 

5 66790). 

6 SEC. 3. INTERACTION OF MEDICARE PAYMENT POLICIES 

7 WITH HEALTH CARE DELIVERY GENERALLY. 

8 Section 1805(b)(2)(C) of the Social Security Act (42 

9 U.S.C. 1395b–6(b)(2)(C)) is amended— 

10 (1) by striking ‘‘GENERALLY.—Specifically,’’ 

11 and inserting ‘‘GENERALLY.— 

12 ‘‘(i) IN GENERAL.—Specifically,’’; and 

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

14 clause: 

15 ‘‘(ii) SPECIAL RULE FOR HOME

16 HEALTH AGENCIES.— 

17 ‘‘(I) IN GENERAL.—When con18 ducting the review of home health 

19 agency financial performance and its 

20 impact on access to care under the 

21 original fee-for-service system, the 

22 Commission shall— 

23 ‘‘(aa) review and report on 

24 aggregate trends in spending, 

25 utilization, and financial performVerDate Sep 11 2014 01:55 Aug 22, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5159.IH H5159

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1 ance under the Medicare Advan2 tage program, the Medicaid pro3 gram under title XIX (both fee4 for-service and managed care 

5 payment models), and other pay6 ers for home health agency serv7 ices; 

8 ‘‘(bb) evaluate and consider 

9 the impact of all payers on access 

10 to care for Medicare bene11 ficiaries; and 

12 ‘‘(cc) comprehensively dis13 close the methodologies used to 

14 evaluate and calculate home 

15 health agency margins under this 

16 title and all other payers, includ17 ing the process for developing the 

18 data used. 

19 Where appropriate, the Commission 

20 shall conduct such reviews in con21 sultation with the Medicaid and CHIP 

22 Payment and Access Commission es23 tablished under section 1900. 

24 ‘‘(II) MEDICARE HOME HEALTH

25 COST REPORT AMENDMENTS.—For 


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1 cost reporting periods beginning in 

2 2025 and subsequent years, the Sec3 retary shall have in effect an amended 

4 Medicare home health cost report that 

5 collects data on visit utilization and 

6 total payments by payer source, in7 cluding original fee-for-service pay8 ments, Medicare Advantage, the Med9 icaid program under title XIX (both 

10 fee-for-service and managed care pay11 ment models), and other payers. The 

12 Secretary shall make such amended 

13 cost reports available to the Commis14 sion in the form and manner nec15 essary to conduct the analysis de16 scribed in subclause (I). 

17 ‘‘(III) FINANCIAL DATA.—Prior 

18 to the availability of cost report data 

19 as described in subclause (II), the 

20 Commission shall utilize data on cost 

21 and revenues from sources it deems as 

22 reliable and valid for purposes of con23 ducting the analysis described in sub24 clause (I).’’. 

Æ 


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