I
105TH CONGRESS
2D SESSION
H. R. 4727
To amend title XVIII of the Social Security Act to delay the 15% reduction
and to make revisions in the per beneficiary and per visit payment
limits on payment for health services under the Medicare Program,
and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 7, 1998
Mr. STARK (for himself, Mr. DINGELL, Mr. BROWN of Ohio, Mr. MATSUI, Mr.
COYNE, Mr. LEVIN, Mr. CARDIN, Mr. MCDERMOTT, and Mr. MCGOV-
ERN) 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
committee concerned
A BILL
To amend title XVIII of the Social Security Act to delay
the 15% reduction and to make revisions in the per
beneficiary and per visit payment limits on payment for
health services under the Medicare Program, and for
other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION. 1. REVISION OF PER BENEFICIARY LIMITS AND
PER VISIT PAYMENT LIMITS FOR PAYMENT
FOR HOME HEALTH SERVICES UNDER THE
MEDICARE PROGRAM.
(a) REVISION OF PER BENEFICIARY LIMITS.—
(1) IN GENERAL.—Section 1861(v)(1)(L)(v) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395x(v)(1)(L)(v)) is amended to read as follows:
‘‘(v)(I) For services furnished by home health agen-
cies for cost reporting periods beginning on or after Octo-
ber 1, 1997, the Secretary shall provide for an interim
system of limits. Payment shall not exceed the costs deter-
mined under the preceding provisions of this subpara-
graph or, if lower, the product of—
‘‘(aa) the applicable amount under subclause
(II) or (III); and
‘‘(bb) the agency’s unduplicated census count of
patients (entitled to benefits under this title) for the
cost reporting period subject to the limitation.
‘‘(II) The applicable limit for cost reporting periods
beginning in fiscal year 1998 is an agency-specific per
beneficiary annual limitation calculated based 75 percent
on 98 percent of the reasonable costs (including nonrou-
tine medical supplies) for the agency’s 12-month cost re-
porting period ending during fiscal year 1994, and based
25 percent on 98 percent of the standardized regional av-
erage of such costs for the agency’s census division, as
applied to such agency, for cost reporting periods ending
during fiscal year 1994, such costs updated by the home
health market basket index.
‘‘(III) The applicable limit for cost reporting periods
beginning on or after October 1, 1998, is an agency-spe-
cific per beneficiary annual limitation calculated—
‘‘(aa) based 50 percent on the per beneficiary
annual limitation determined under subclause (II)
for the agency;
‘‘(bb) based 25 percent on the standardized na-
tional mean equal to $3,708.25 for fiscal year 1999
(of which $2,880.12 is the labor component, and
$828.13 is the non-labor component); and
‘‘(cc) based 25 percent on the standardized re-
gional average of the limits for the agency’s census
division (as specified in Tables 3B and 3D published
in the Federal Register on August 11, 1998 (63 FR
42926));
such limits updated by the home health market basket for
each subsequent fiscal year (if any) through the fiscal year
involved.’’.
(2) NEW AGENCIES.—Section 1861(v)(1)(L)(vi)
of 
the 
Social 
Security 
Act 
(42 
U.S.C.
1395x(v)(1)(L)(vi)) is amended—
(A) in subclause (I), by striking ‘‘For new’’
and inserting ‘‘Subject to subclause (II), for
new’’;
(B) by redesignating subclause (II) as sub-
clause (III); and
(C) by inserting after subclause (I) the fol-
lowing:
‘‘(II) In the case of cost reporting periods be-
ginning on or after October 1, 1998, the limits in
subclause (I) shall be determined as if any reference
in clause (v)(II) to ‘98 percent’ were a reference to
‘100 percent’.
(3) 
CONFORMING
AMENDMENT.—Section
1861(v)(1)(L)(vii)(I) of the Social Security Act (42
U.S.C. 1395x(v)(1)(L)(vii)(I)) is amended by strik-
ing ‘‘clause (v)(I)’’ and inserting ‘‘clause (v)(II)’’.
(b) REVISION
OF
PER
VISIT
LIMITS.—Section
1861(v)(1)(L)(i) 
of 
such 
Act 
(42 
U.S.C.
1395x(v)(1)(L)(i)) is amended—
(1) in subclause (III), by striking ‘‘or’’;
(2) in subclause (IV)—
(A) by inserting ‘‘and before October 1,
1998,’’ after ‘‘October 1, 1997,’’; and
(B) by striking the period at the end and
inserting ‘‘, or’’; and
(3) by adding at the end the following new sub-
clause:
‘‘(V) October 1, 1998, 110 percent of such me-
dian.’’.
(c) ONE-YEAR DELAY IN IMPLEMENTATION OF MAN-
DATORY
REDUCTION
IN
PAYMENT
LIMITS.—Section
4603(e) of the Balanced Budget Act of 1997 (42 U.S.C.
1395fff note) is amended—
(1) by striking ‘‘described in subsection (d)’’
and inserting ‘‘beginning on or after October 1,
2000’’; and
(2) by striking ‘‘September 30, 1999’’ and in-
serting ‘‘September 30, 2000’’.
(d) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall apply to cost reporting peri-
ods beginning on or after October 1, 1998.
SEC. 2. TWO OFFSETS.
(a) CHANGE IN NUMBER OF INDIVIDUALS ELIGIBLE
TO
ENROLL
UNDER
MEDICARE
MSA.—Section
1851(b)(4)(A)(ii) of the Social Security Act (42 U.S.C.
1395w–21(b)(4)(A)(ii)) is amended by striking ‘‘390,000’’
and inserting ‘‘100,000 (for any date before January 1,
2004) or 500,000 (for any date thereafter)’’.
(b) THREE-YEAR EXTENSION OF MEDICARE MSA
TERMINATION DATE.—Section 1851(b)(4)(A)(i) of the
Social Security Act (42 U.S.C. 1395w–21(b)(4)(A)(i)) is
amended by striking ‘‘2003’’ and inserting ‘‘2006’’.
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