I
106TH CONGRESS
2D SESSION
H. R. 5163
To amend title XVIII of the Social Security Act with respect to payments
made under the prospective payment system for home health services
furnished under the Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 13, 2000
Mr. MCGOVERN (for himself, Mr. PETERSON of Pennsylvania, Mr. HILLIARD,
Mr. WATKINS, Mr. JEFFERSON, Mr. ENGLISH, Mr. MCINTOSH, Mrs.
THURMAN, Mr. HILLEARY, Mr. WEYGAND, Mr. SANDERS, Mr. COOK, Mr.
RAHALL, Mr. TIERNEY, Mr. MOAKLEY, Mr. WAMP, Mr. POMEROY, Mr.
CONYERS, Mr. GOODE, Mr. DICKEY, Mr. DOYLE, Mr. FRANK of Massa-
chusetts, Mr. NEY, Ms. MILLENDER-MCDONALD, Mr. ROMERO-BARCELO´,
Mr. FROST, Mr. KIND, Mr. BALDACCI, Mr. OLVER, Mr. MURTHA, Mr.
GOODLING, and Mr. ALLEN) introduced the following bill; which was re-
ferred 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 with-
in the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act with respect
to payments made under the prospective payment system
for home health services furnished under the Medicare
Program.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Home Health Refine-
ment Amendments of 2000’’.
SEC. 2. ELIMINATION OF 15 PERCENT REDUCTION IN PAY-
MENT RATES UNDER THE MEDICARE PRO-
SPECTIVE 
PAYMENT 
SYSTEM 
FOR 
HOME
HEALTH SERVICES.
(a) IN GENERAL.—Section 1895(b)(3)(A) of the So-
cial Security Act (42 U.S.C. 1395fff(b)(3)(A)), as amend-
ed by sections 302(b) and 303(f) of the Medicare, Med-
icaid, and SCHIP Balanced Budget Refinement Act of
1999 (113 Stat. 1501A–359, 361), as enacted into law
by section 1000(a)(6) of Public Law 106–113, is amended
to read as follows:
‘‘(A) INITIAL BASIS.—Under such system
the Secretary shall provide for computation of
a standard prospective payment amount (or
amounts). Such amount (or amounts) shall ini-
tially be based on the most current audited cost
report data available to the Secretary and shall
be computed in a manner so that the total
amounts payable under the system for the 12-
month period beginning on the date the Sec-
retary implements the system shall be equal to
the total amount that would have been made if
the system had not been in effect and if section
1861(v)(1)(L)(ix) had not been enacted. Each
such amount shall be standardized in a manner
that eliminates the effect of variations in rel-
ative case mix and area wage adjustments
among different home health agencies in a
budget neutral manner consistent with the case
mix and wage level adjustments provided under
paragraph (4)(A). Under the system, the Sec-
retary may recognize regional differences or dif-
ferences based upon whether or not the services
or agency are in an urbanized area.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect as if included in the enact-
ment of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999 (Public Law 106–113).
SEC. 3. ADDITIONAL PAYMENTS FOR OUTLIERS.
(a) IN GENERAL.—Section 1895(b)(5) of the Social
Security Act (42 U.S.C. 1395fff(b)(5)) is amended—
(1) by striking ‘‘OUTLIERS.—The Secretary’’
and inserting the following (and conforming the in-
dentation of the succeeding matter accordingly):
‘‘OUTLIERS.—
‘‘(A) IN GENERAL.—The Secretary’’; and
(2) by adding at the end the following new sub-
paragraph:
‘‘(B) TEMPORARY ADDITIONAL PAYMENTS
FOR OUTLIERS.—For the purposes described in
the first sentence of subparagraph (A), there
are authorized to be appropriated from the
trust funds (as defined in section 1896(a)(8))
in appropriate part, as determined by the Sec-
retary, for each of fiscal years 2001 through
2005 an amount equal to $500,000,000. Such
amounts shall be in addition to amounts avail-
able for payment under this section and shall
not result in an reduction of the standard pro-
spective payment amount (or amounts). In
making payments under this subparagraph, the
Secretary shall use a loss-sharing ratio of 90
percent.’’.
(b) 
CONFORMING
AMENDMENT.—Section
1895(b)(3)(C) of such Act (42 U.S.C. 1395fff(b)(3)(C))
is amended by striking ‘‘paragraph (5)’’ and inserting
‘‘paragraph (5)(A)’’.
SEC. 4. ADDITIONAL PAYMENTS UNDER THE PROSPECTIVE
PAYMENT 
SYSTEM 
FOR 
SERVICES 
FUR-
NISHED IN RURAL AREAS AND SECURITY
SERVICES.
(a) INCREASE
IN PAYMENT RATES
FOR RURAL
AGENCIES.—Section 1895(b) of the Social Security Act
(42 U.S.C. 1395fff(b)) is amended by adding at the end
the following new paragraph:
‘‘(7) ADDITIONAL
PAYMENT
AMOUNT
FOR
SERVICES
FURNISHED
IN
RURAL
AREAS.—In the
case of home health services furnished in a rural
area (as defined in section 1886(d)(2)(D)), notwith-
standing any other provision of this subsection, the
amount of payment for such services is equal to 110
percent of the payment amount otherwise made
under this section (but for this paragraph) for serv-
ices furnished in a rural area.’’.
(b) ADDITIONAL PAYMENT
FOR SECURITY SERV-
ICES.—Section 
1895(b) 
of 
such 
Act 
(42 
U.S.C.
1395fff(b)(3)), as amended by subsection (a), is further
amended by adding at the end the following paragraph:
‘‘(8) ADDITIONAL
PAYMENT
FOR
SECURITY
SERVICES.—The Secretary shall provide for an addi-
tion or adjustment to the payment amount otherwise
made under this section for the reasonable cost (as
defined in section 1861(v)(1)(A)) of furnishing pro-
tective services to individuals furnishing home health
services under this title in areas where such individ-
uals are at risk of physical harm, as determined by
the Secretary.’’.