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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3495 Introduced in House (IH)]

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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``Preserving 
Equitable Access to Community-based Home Health (PEACH) Act of 2009''.
    (b) Purpose.--It is the purpose of this Act to preserve access to 
home health services for all Americans, regardless of their ability to 
pay or their severity of illness.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) The Medicare home health benefit is vulnerable to 
        agency selection of the most profitable beneficiaries and 
        avoidance of the most complex and costly beneficiaries.
            (2) Such ``cherry picking'' by some home health agencies 
        compromises access to care for the most complex, highest risk 
        beneficiaries.
            (3) The Government Accountability Office has reported that 
        hospital discharge planners have difficulty placing more than 
        10 percent of eligible patients in home health due to their 
        extensive care needs.
            (4) Proposals to reduce Medicare payments to home health 
        agencies (in response to large aggregate margins across all 
        home health agencies) may undermine the financial viability of 
        mission-driven and non-profit home health agencies, which often 
        have low to negative margins, while allowing high-margin 
        agencies to remain in operation.

SEC. 3. SUPPLEMENTAL PAYMENTS FOR PEACH AGENCIES.

    (a) In General.--There shall be established a fund (to be known as 
the ``PEACH fund'') from which home health agencies meeting specified 
criteria shall be paid supplemental amounts in addition to their 
statutory payment amounts under title XVIII of the Social Security Act. 
Is this to be a trust fund? Where is this fund to be established? Who 
adminsters it? What are the sources of funding that goes into the fund? 
What are the allowed uses of such funding?
    (b) Peach Program.--Title XVIII of the Social Security Act is 
amended by inserting after section 1895 the following new section:

               ``supplemental payments for peach agencies

    ``Sec. 1895A.  (a) Designation.--
            ``(1) In general.--The Secretary shall designate as a 
        `PEACH agency' any home health agency that meets the criteria 
        under paragraph (2).
            ``(2) Criteria.--The Secretary may not designate a home 
        health agency as a PEACH agency unless the home health agency 
        meets the following criteria:
                    ``(A) The home health agency is certified for 
                participation under this title.
                    ``(B) The home health agency offers--
                            ``(i) the complete range of home health 
                        services as defined under section 1861(m) of 
                        this title;
                            ``(ii) the complete range of home health 
                        services on a 24 hours per day, 7 days per week 
                        on-call basis; and
                            ``(iii) its services to all eligible 
                        beneficiaries or enrollees under this title 
                        and/or title XIX, and uninsured individuals up 
                        to its service capacity, regardless of their 
                        ability to pay or the complexity or intensity 
                        of care they require.
                    ``(C) The home health agency provides charity care 
                in an amount greater than or equal to 1 percent of its 
                total revenue.
                    ``(D) The home health agency agrees that the 
                Secretary may, by statistical or other means, verify on 
                an annual basis that the agency meets the criteria 
                defined in this paragraph, and that the agency will be 
                subject to disqualification from the PEACH program if 
                such criteria are not met.
    ``(b) Supplemental Payments.--
            ``(1) In general.--Subject to the availability of funds 
        under subsection (c), the Secretary shall make supplemental 
        payments to PEACH agencies based on information submitted by 
        the agency on an additional schedule in the Medicare cost 
        report.
            ``(2) Cost reporting.--The Secretary shall implement an 
        additional schedule, as a component of the cost reporting 
        process, on which home health agencies may report information 
        the Secretary deems necessary for designation and payment as a 
        PEACH agency.
            ``(3) Amount and timing for first year as peach agency.--
                    ``(A) The supplemental payment made to a home 
                health agency for the first year in which such agency 
                is designated a PEACH agency under this section shall 
                be equal to its shortfall in that year, defined as the 
                sum of--
                            ``(i) the aggregate reasonable cost of home 
                        health services delivered under parts A and B 
                        of this title by the PEACH agency for such 
                        year, less the aggregate payments received by 
                        the PEACH agency pursuant to section 1895;
                            ``(ii) the aggregate actual costs of home 
                        health and home and community based services 
                        delivered by the agency under sections 
                        1905(a)(7), 1905(a)(22), and 1915(c) through 
                        (e) of title XIX for such year, less the 
                        aggregate payments received by the PEACH agency 
                        for such services under that title; and
                            ``(iii) the aggregate cost of uncompensated 
                        home health services delivered by the PEACH 
                        agency for such year.
                    ``(B) The supplemental payment under subparagraph 
                (A) shall be paid within 90 days of receipt of the 
                annual cost report by the Secretary.
            ``(4) Amount and timing for subsequent years.--For each 
        year after the first year in which a home health agency is 
        designated a PEACH agency, a PEACH agency shall receive interim 
        supplemental payments based on--
                    ``(A) the intervals at which the agency submits 
                cost reports; and
                    ``(B) the estimated shortfall, as defined in 
                subparagraph (3)(A), for the year or interval in 
                question.
    ``(c) Funding.--Supplemental payments under this section shall be--
            ``(1) paid from the PEACH fund, which shall be capped at 
        $500,000,000 annually and shall be administered by the 
        Secretary; and
            ``(2) paid to PEACH agencies--
                    ``(A) pursuant to subsection (b); or
                    ``(B) if the PEACH fund is insufficient to cover 
                all the supplemental payments that should be paid under 
                subsection (b), in proportion to each agency's 
                shortfall relative to the aggregate shortfall of all 
                PEACH agencies for the year in question.
        In any year in which the Secretary determines that the PEACH 
        fund will not cover the aggregate estimated shortfall of all 
        PEACH agencies, the Secretary shall make a preliminary 
        supplemental payment to each PEACH agency within 90 days of 
        receipt of its annual cost report and, if funds remain, an 
        additional supplemental payment after all PEACH agency cost 
        reports have been received.
    ``(d) Definitions.--For purposes of this section--
            ``(1) the term `charity care' means home health services 
        that are provided to an individual who is--
                    ``(A) not eligible for payment under this title, 
                under title XIX, or by any other third-party payer; and
                    ``(B) unable to pay any portion of the full cost of 
                care, including any amount subsidized or otherwise 
                discounted due to an individual's inability to pay; and
            ``(2) the term `uncompensated care' means home health 
        services provided to an individual by a home health agency with 
        the knowledge that the individual will be financially unable to 
        pay for the services.''.
    (c) Conforming Amendment.--Section 1895(a) of the Social Security 
Act is amended by inserting before the period at the end the following: 
``and the provisions of section 1895A''.

SEC. 4. REGULATIONS.

    The Secretary shall issue such regulations as are necessary and 
appropriate for the implementation of the provisions of this Act.

SEC. 5. AUTHORIZATION OF APPROPRIATIONS.

    There is authorized for appropriation $500,000,000 for each fiscal 
year beginning with fiscal year 2010 for purposes of carrying out the 
purposes of this Act. Is there anything this funds other than the PEACH 
fund? Should this go into the provision creating that fund?
                                 <all>
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