I
105TH CONGRESS
2D SESSION
H. R. 4252
To amend title XVIII of the Social Security Act to revise the interim payment
system for home health care furnished to Medicare beneficiaries.
IN THE HOUSE OF REPRESENTATIVES
JULY 16, 1998
Mr. ENGLISH of Pennsylvania (for himself and Mr. NEAL of Massachusetts)
introduced the following bill; which was referred to the Committee on
Ways and Means, and in addition to the Committee on 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 com-
mittee concerned
A BILL
To amend title XVIII of the Social Security Act to revise
the interim payment system for home health care fur-
nished to Medicare beneficiaries.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. MODIFICATIONS TO INTERIM PAYMENT SYS-
TEM FOR HOME HEALTH SERVICES UNDER
MEDICARE.
(a) PER VISIT COST LIMITS.—
(1) 
BASIS
FOR
LIMITS.—Section
1861(v)(1)(L)(i) of the Social Security Act (42
U.S.C. 1395x(v)(1)(L)(i)) is amended—
(A) by inserting ‘‘or’’ at the end of sub-
clause (II);
(B) in subclause (III)—
(i) by striking ‘‘and before October 1,
1997’’; and
(ii) by striking ‘‘, or’’ and inserting a
period; and
(C) by striking subclause (IV).
(2) ELIMINATION OF OUT-YEAR EFFECT OF 2-
YEAR FREEZE.—Section 1861(v)(1)(L) (42 U.S.C.
1395x(v)(1)(L)) is amended—
(A) by striking clause (iv) and redesignat-
ing clauses (v) and (vi) as clauses (iv) and (v),
respectively; and
(B) in clause (vii), by striking ‘‘clause
(v)(I)’’ and inserting ‘‘clause (iv)(I)’’.
(b) PER
BENEFICIARY
COST
LIMITS.—Section
1861(v)(1)(L) of such Act (42 U.S.C. 1395x(v)(1)(L)) is
amended—
(1) by amending subclause (I) of clause (iv) (as
redesignated by subsection (a)(2)(A)) to read as fol-
lows:
‘‘(I) a per beneficiary annual limitation cal-
culated based 50 percent on the standardized aver-
age of reasonable costs (including nonroutine medi-
cal supplies) for agencies in the State in which an
agency is located for cost reporting periods ending
during fiscal year 1994, updated by the home health
market basket index, and 50 percent on the stand-
ardized national average of reasonable costs (includ-
ing nonroutine medical supplies) for all agencies for
cost reporting periods ending during fiscal year
1994, updated by the home health market basket
index; and’’; and
(2) in clause (v) (as redesignated by subsection
(a)(2)(A)), by striking ‘‘the following rules’’ and all
that follows and inserting in lieu thereof ‘‘the per
beneficiary limitation established under clause (iv)
shall, for beneficiaries who use services furnished by
more than one home health agency, be prorated
among such agencies.’’.
(c) EFFICIENCY STANDARD.—Section 1861(v)(1)(L)
of such Act (42 U.S.C. 1395x(v)(1)(L)) is amended—
(1) in clause (iv) (as redesignated by subsection
(a)(2)(A)), by striking ‘‘Payment’’ and inserting in
lieu thereof ‘‘Except as provided in clause (vi), pay-
ment’’; and
(2) by inserting after clause (v) (as redesig-
nated by subsection (a)(2)(A)) the following new
clause:
‘‘(vi)(I) Notwithstanding clause (iv), for any cost re-
porting period beginning on or after October 1, 1997, for
which a home health agency’s reasonable costs per bene-
ficiary (as limited by clause (i)) do not exceed the wage-
adjusted national average per beneficiary amount de-
scribed in subclause (II), payment to such agency shall
equal the agency’s reasonable costs determined under
clause (i).
‘‘(II) For purposes of subclause (I), the ‘wage-ad-
justed national average per beneficiary amount’ for a
home health agency for a cost reporting period is the na-
tional average per beneficiary reasonable costs for all
home health agencies for cost reporting periods beginning
in fiscal year 1994 (as determined by the Secretary), up-
dated by the home health market basket and adjusted for
the wage-related portion of such costs by the wage index
described in clause (iii).’’.
(d) CONTINGENT APPLICATION OF EXISTING LIM-
ITS.—Section 4603(e) of the Balanced Budget Act of
1997 is amended by striking ‘‘a reduction by 15 percent
in’’ and inserting ‘‘the application of ’’.
(e) EFFECTIVE DATE.—The amendments made by
this section shall take effect as if included in the enact-
ment of the Balanced Budget Act of 1997.
Æ