Home Health Payment Innovation Act of 2019

To amend title XVIII of the Social Security Act to improve home health payment reforms under the Medicare program. 1. Short title This Act may be cited as the Home Health Payment Innovation Act of 2019 2. Improvements to Medicare innovations and managed care related to home health services (a) Expanded waivers in shared savings programs Section 1899(f) of the Social Security Act ( 42 U.S.C. 395jjj(f) Beginning not later than January 1, 2020, the Secretary shall include a waiver of the confined to his home (b) Flexibility in Medicare advantage plans Section 1852 of the Social Security Act ( 42 U.S.C. 1395ww–2 (o) Flexibility if providing home health services Notwithstanding any other provision of law, any MA organization shall be permitted to waive the confined to his home . 3. Improvements to home health payment reforms under Medicare (a) Application of budget neutrality Section 1895(b)(3) of the Social Security Act ( 42 U.S.C. 1395fff(b)(3) Public Law 115–123 (1) in subparagraph (A)(iv), in the fourth sentence— (A) by striking shall make shall not make (B) by striking and shall provide a description (2) in subparagraph (D)— (A) in the subparagraph heading, by striking assumptions evidence (B) in clause (i)— (i) by striking differences between assumed and actual (ii) by inserting attributable to the implementation of paragraphs (2)(B) and (4)(B) behavior changes (iii) by adding at the end the following: The Secretary shall publish the determination under this clause with respect to an applicable year, including a description of the evidence used to make such determination, in the notice and comment rulemaking to update the prospective payment system under this subsection for such year. For purposes of the preceding sentence, the term evidence Public Law 115–123 (C) in clause (ii), by inserting attributable to the implementation of paragraphs (2)(B) and (4)(B) expenditures (D) in clause (iii)— (i) by adding attributable to the implementation of paragraphs (2)(B) and (4)(B) expenditures (ii) by adding at the end the following: If such a temporary increase or decrease does not exceed 2.00 percent in any given year, the Secretary shall apply the entire increase or decrease in the next calendar year payment update. In the case where such a temporary increase or decrease exceeds 2.00 percent, the Secretary shall phase in the temporary increase or decrease in equal amounts not to exceed 2.00 percent in any given year through the respective calendar year payment updates. Notwithstanding the preceding sentence, the Secretary shall complete any such phase-in adjustment no later than 2029 and shall have the authority, after 2025, to waive the phase-in requirement as necessary to achieve budget neutrality by 2029. Prior to implementing such phase-in adjustments after 2025, the Secretary shall first receive certification from the Office of the Actuary of the Centers for Medicare & Medicaid Services that any such adjustments are appropriate. (b) Effective date The amendments made by this section shall take effect as if included in the enactment of such section 51001(a)(2).

Summary: Home Health Payment Innovation Act of 2019 This bill makes a series of changes relating to payment and coverage of home health services under Medicare and Medicare Advantage (MA). Specifically, the bill allows the home-confinement requirement (also known as the homebound requirement) for home health services to be waived under Medicare and MA. Currently, as a condition of eligibility for such services, a physician must certify that an individual has difficulty leaving home without assistance (e.g., a wheelchair, special transportation, or help from another person) due to an illness or injury. The bill also alters the payment methodology under the Medicare prospective payment system for home health services, including by eliminating the requirement that such methodology include certain behavioral assumptions regarding the implementation of specified changes to units of payment and case-mix adjustment factors.