II 

111TH CONGRESS 

2D SESSION S. 3315 

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

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

IN THE SENATE OF THE UNITED STATES 

MAY 5, 2010 

Ms. COLLINS (for herself and Mr. FEINGOLD) 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 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’’. 

6 SEC. 2. PROTECTING ACCESS TO MEDICARE HOME HEALTH 

7 SERVICES. 

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

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


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1 of the Patient Protection and Affordable Care Act (Public 

2 Law 111–148), is amended— 

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

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

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

6 clause: 

7 ‘‘(vii) SPECIAL RULES FOR ADJUST8 MENT FOR CASE MIX CHANGES FOR 2011

9 AND SUBSEQUENT YEARS.— 

10 ‘‘(I) IN GENERAL.—For 2011 

11 and each subsequent year, subject to 

12 subclause (IV), any adjustment under 

13 clause (iv) shall only be made using 

14 standards established by the Secretary 

15 consistent with the processes de16 scribed in subclause (II) and taking 

17 into account the considerations de18 scribed in subclause (III). 

19 ‘‘(II) PROCESSES AND CRITERIA

20 FOR EVALUATING CHANGES IN CASE

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

22 the processes described in this sub23 clause are the following: 

24 ‘‘(aa) The Secretary shall 

25 convene a Technical Advisory 


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1 Group to advise the Secretary 

2 concerning the establishment of 

3 standards under subclause (I) in 

4 order to distinguish between real 

5 changes in case mix and changes 

6 in coding or classification of dif7 ferent units of services that do 

8 not reflect real changes in case 

9 mix. The Technical Advisory 

10 Group shall be composed of 

11 stakeholders, including an equal 

12 number of individuals and orga13 nizations representing the inter14 ests of Medicare beneficiaries, the 

15 National Association for Home 

16 Care and Hospice, the Visiting 

17 Nurse Associations of America, 

18 health care academia, and health 

19 care professionals. Members shall 

20 not have an existing contractual 

21 relationship with the Secretary at 

22 the time of their appointment to 

23 the Technical Advisory Group. 

24 The Secretary shall provide the 

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1 portunity to review and comment 

2 on any proposed rulemaking or 

3 final determination of the Sec4 retary with respect to such stand5 ards prior to the issuance of the 

6 proposed rulemaking or making 

7 of the final determination. 

8 ‘‘(bb) If the Secretary en9 gages an outside contractor to 

10 participate in the evaluation of 

11 case mix changes described in 

12 item (aa), the Secretary shall 

13 only utilize an outside contractor 

14 that has not previously partici15 pated in the design and establish16 ment of the case mix adjustment 

17 factors under paragraph (4)(B). 

18 ‘‘(cc) If the Secretary deter19 mines that any increase in case 

20 mix relates to changes in the vol21 ume or nature of home health 

22 services provided, the Secretary 

23 shall evaluate that increase 

24 through the actual review of 

25 claims and services and shall not 


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1 use any proxy or surrogate for 

2 determining whether the change 

3 in volume or nature of services is 

4 reasonable and necessary. 

5 ‘‘(dd) The Secretary shall 

6 establish such standards by regu7 lation. 

8 ‘‘(ee) The Secretary shall 

9 make available to the public all 

10 data, reports, and supporting 

11 materials, including any com12 ments by the Technical Advisory 

13 Group under item (aa), regarding 

14 the establishment of such stand15 ards at the time of the publica16 tion of the notice of the proposed 

17 regulation. 

18 ‘‘(III) CONSIDERATIONS.—For 

19 purposes of subclause (I), the consid20 erations described in this subclause 

21 are the following: 

22 ‘‘(aa) The impact of changes 

23 in the program under this title 

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1 tics of individuals receiving home 

2 health services. 

3 ‘‘(bb) The impact of changes 

4 in the provision of home health 

5 services by providers of services 

6 and suppliers other than home 

7 health agencies. 

8 ‘‘(cc) Distinctions in the 

9 characteristics of individuals ini10 tiating home health services from 

11 community and institutional care 

12 settings. 

13 ‘‘(dd) Whether any changes 

14 in coding resulted in a change in 

15 aggregate payments under this 

16 subsection during the fiscal year 

17 or year and disregarding changes 

18 in coding that did not result in 

19 such a change in aggregate pay20 ments. 

21 ‘‘(ee) Any other factors de22 termined appropriate by the Sec23 retary, in consultation with the 

24 Technical Advisory Group under 

25 subclause (II)(aa). 


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1 ‘‘(IV) EXCEPTION FOR CERTAIN

2 ADJUSTMENTS FOR 2011.—This clause 

3 shall not apply to any adjustment 

4 under clause (iv) that is scheduled for 

5 2011 as of January 1, 2010.’’. 

Æ 


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