I 

111TH CONGRESS 

1ST SESSION H. R. 3495 

To amend title XVIII of the Social Security Act to ensure access to quality 

home health services for all Americans, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 31, 2009 

Ms. KAPTUR 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 

access to quality home health services for all Americans, 

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; PURPOSE. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Preserving Equitable Access to Community-based Home 

6 Health (PEACH) Act of 2009’’. 


jlentini on DSKJ8SOYB1PROD with BILLS
2 

•HR 3495 IH

1 (b) PURPOSE.—It is the purpose of this Act to pre2 serve access to home health services for all Americans, re3 gardless of their ability to pay or their severity of illness. 

4 SEC. 2. FINDINGS. 

5 The Congress finds the following: 

6 (1) The Medicare home health benefit is vulner7 able to agency selection of the most profitable bene8 ficiaries and avoidance of the most complex and 

9 costly beneficiaries. 

10 (2) Such ‘‘cherry picking’’ by some home health 

11 agencies compromises access to care for the most 

12 complex, highest risk beneficiaries. 

13 (3) The Government Accountability Office has 

14 reported that hospital discharge planners have dif15 ficulty placing more than 10 percent of eligible pa16 tients in home health due to their extensive care 

17 needs. 

18 (4) Proposals to reduce Medicare payments to 

19 home health agencies (in response to large aggregate 

20 margins across all home health agencies) may under21 mine the financial viability of mission-driven and 

22 non-profit home health agencies, which often have 

23 low to negative margins, while allowing high-margin 

24 agencies to remain in operation. 


jlentini on DSKJ8SOYB1PROD with BILLS
3 

•HR 3495 IH

1 SEC. 3. SUPPLEMENTAL PAYMENTS FOR PEACH AGENCIES. 

2 (a) IN GENERAL.—There shall be established a fund 

3 (to be known as the ‘‘PEACH fund’’) from which home 

4 health agencies meeting specified criteria shall be paid 

5 supplemental amounts in addition to their statutory pay6 ment amounts under title XVIII of the Social Security 

7 Act. Is this to be a trust fund? Where is this fund to be 

8 established? Who adminsters it? What are the sources of 

9 funding that goes into the fund? What are the allowed 

10 uses of such funding? 

11 (b) PEACH PROGRAM.—Title XVIII of the Social Se12 curity Act is amended by inserting after section 1895 the 

13 following new section: 

14 ‘‘SUPPLEMENTAL PAYMENTS FOR PEACH AGENCIES

15 ‘‘SEC. 1895A. (a) DESIGNATION.— 

16 ‘‘(1) IN GENERAL.—The Secretary shall des17 ignate as a ‘PEACH agency’ any home health agen18 cy that meets the criteria under paragraph (2). 

19 ‘‘(2) CRITERIA.—The Secretary may not des20 ignate a home health agency as a PEACH agency 

21 unless the home health agency meets the following 

22 criteria: 

23 ‘‘(A) The home health agency is certified 

24 for participation under this title. 

25 ‘‘(B) The home health agency offers— 


jlentini on DSKJ8SOYB1PROD with BILLS
4 

•HR 3495 IH

1 ‘‘(i) the complete range of home 

2 health services as defined under section 

3 1861(m) of this title; 

4 ‘‘(ii) the complete range of home 

5 health services on a 24 hours per day, 7 

6 days per week on-call basis; and 

7 ‘‘(iii) its services to all eligible bene8 ficiaries or enrollees under this title and/or 

9 title XIX, and uninsured individuals up to 

10 its service capacity, regardless of their abil11 ity to pay or the complexity or intensity of 

12 care they require. 

13 ‘‘(C) The home health agency provides 

14 charity care in an amount greater than or equal 

15 to 1 percent of its total revenue. 

16 ‘‘(D) The home health agency agrees that 

17 the Secretary may, by statistical or other 

18 means, verify on an annual basis that the agen19 cy meets the criteria defined in this paragraph, 

20 and that the agency will be subject to disquali21 fication from the PEACH program if such cri22 teria are not met. 

23 ‘‘(b) SUPPLEMENTAL PAYMENTS.— 

24 ‘‘(1) IN GENERAL.—Subject to the availability 

25 of funds under subsection (c), the Secretary shall 


jlentini on DSKJ8SOYB1PROD with BILLS
5 

•HR 3495 IH

1 make supplemental payments to PEACH agencies 

2 based on information submitted by the agency on an 

3 additional schedule in the Medicare cost report. 

4 ‘‘(2) COST REPORTING.—The Secretary shall 

5 implement an additional schedule, as a component of 

6 the cost reporting process, on which home health 

7 agencies may report information the Secretary 

8 deems necessary for designation and payment as a 

9 PEACH agency. 

10 ‘‘(3) AMOUNT AND TIMING FOR FIRST YEAR AS

11 PEACH AGENCY.— 

12 ‘‘(A) The supplemental payment made to a 

13 home health agency for the first year in which 

14 such agency is designated a PEACH agency 

15 under this section shall be equal to its shortfall 

16 in that year, defined as the sum of— 

17 ‘‘(i) the aggregate reasonable cost of 

18 home health services delivered under parts 

19 A and B of this title by the PEACH agen20 cy for such year, less the aggregate pay21 ments received by the PEACH agency pur22 suant to section 1895; 

23 ‘‘(ii) the aggregate actual costs of 

24 home health and home and community 

25 based services delivered by the agency 


jlentini on DSKJ8SOYB1PROD with BILLS
6 

•HR 3495 IH

1 under sections 1905(a)(7), 1905(a)(22), 

2 and 1915(c) through (e) of title XIX for 

3 such year, less the aggregate payments re4 ceived by the PEACH agency for such 

5 services under that title; and 

6 ‘‘(iii) the aggregate cost of uncompen7 sated home health services delivered by the 

8 PEACH agency for such year. 

9 ‘‘(B) The supplemental payment under 

10 subparagraph (A) shall be paid within 90 days 

11 of receipt of the annual cost report by the Sec12 retary. 

13 ‘‘(4) AMOUNT AND TIMING FOR SUBSEQUENT

14 YEARS.—For each year after the first year in which 

15 a home health agency is designated a PEACH agen16 cy, a PEACH agency shall receive interim supple17 mental payments based on— 

18 ‘‘(A) the intervals at which the agency sub19 mits cost reports; and 

20 ‘‘(B) the estimated shortfall, as defined in 

21 subparagraph (3)(A), for the year or interval in 

22 question. 

23 ‘‘(c) FUNDING.—Supplemental payments under this 

24 section shall be— 


jlentini on DSKJ8SOYB1PROD with BILLS
7 

•HR 3495 IH

1 ‘‘(1) paid from the PEACH fund, which shall 

2 be capped at $500,000,000 annually and shall be 

3 administered by the Secretary; and 

4 ‘‘(2) paid to PEACH agencies— 

5 ‘‘(A) pursuant to subsection (b); or 

6 ‘‘(B) if the PEACH fund is insufficient to 

7 cover all the supplemental payments that should 

8 be paid under subsection (b), in proportion to 

9 each agency’s shortfall relative to the aggregate 

10 shortfall of all PEACH agencies for the year in 

11 question. 

12 In any year in which the Secretary determines that 

13 the PEACH fund will not cover the aggregate esti14 mated shortfall of all PEACH agencies, the Sec15 retary shall make a preliminary supplemental pay16 ment to each PEACH agency within 90 days of re17 ceipt of its annual cost report and, if funds remain, 

18 an additional supplemental payment after all 

19 PEACH agency cost reports have been received. 

20 ‘‘(d) DEFINITIONS.—For purposes of this section— 

21 ‘‘(1) the term ‘charity care’ means home health 

22 services that are provided to an individual who is— 

23 ‘‘(A) not eligible for payment under this 

24 title, under title XIX, or by any other third25 party payer; and 


jlentini on DSKJ8SOYB1PROD with BILLS
8 

•HR 3495 IH

1 ‘‘(B) unable to pay any portion of the full 

2 cost of care, including any amount subsidized 

3 or otherwise discounted due to an individual’s 

4 inability to pay; and 

5 ‘‘(2) the term ‘uncompensated care’ means 

6 home health services provided to an individual by a 

7 home health agency with the knowledge that the in8 dividual will be financially unable to pay for the 

9 services.’’. 

10 (c) CONFORMING AMENDMENT.—Section 1895(a) of 

11 the Social Security Act is amended by inserting before the 

12 period at the end the following: ‘‘and the provisions of sec13 tion 1895A’’. 

14 SEC. 4. REGULATIONS. 

15 The Secretary shall issue such regulations as are nec16 essary and appropriate for the implementation of the pro17 visions of this Act. 

18 SEC. 5. AUTHORIZATION OF APPROPRIATIONS. 

19 There is authorized for appropriation $500,000,000 

20 for each fiscal year beginning with fiscal year 2010 for 

21 purposes of carrying out the purposes of this Act. Is there 

22 anything this funds other than the PEACH fund? Should 

23 this go into the provision creating that fund? 

Æ 


jlentini on DSKJ8SOYB1PROD with BILLS