I
106TH CONGRESS
1ST SESSION
H. R. 1917
To direct the Secretary of Health and Human Services to make additional
payments under the Medicare Program to certain home health agencies
with high-cost patients, to provide for an interest-free grace period for
the repayment of overpayments made by the Secretary to home health
agencies, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
MAY 25, 1999
Mr. MCGOVERN (for himself, Mr. COBURN, Mr. WEYGAND, Mr. BARTON of
Texas, Mr. MCINTOSH, Mr. RAHALL, Mr. HILLEARY, Ms. HOOLEY of Or-
egon, Mr. WAMP, and Mr. ACKERMAN) introduced the following bill;
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Commerce, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions
as fall within the jurisdiction of the committee concerned
A BILL
To direct the Secretary of Health and Human Services to
make additional payments under the Medicare Program
to certain home health agencies with high-cost patients,
to provide for an interest-free grace period for the repay-
ment of overpayments made by the Secretary to home
health agencies, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
(c) DESCRIPTION OF DIAGNOSIS.—A diagnosis de-
scribed in this subsection is one of the following diagnoses
as classified in St. Anthony’s ICD–9–CM Code Book for
Physician Payment:
(1) diabetes mellitus (ICD–9–CM code 250).
(2) essential hypertension (ICD–9–CM code
401).
(3) other forms of chronic ischemic heart dis-
ease (ICD–9–CM code 414).
(4) heart failure (ICD–9–CM code 428).
(5) acute, but ill-defined cerebrovascular disease
(ICD–9–CM code 436).
(6) pneumonia, organism unspecified (ICD–9–
CM code 486).
(7) chronic airway obstruction, not elsewhere
classified (ICD–9–CM code 496).
(8) chronic ulcer of skin (ICD–9–CM code
707).
(9) symptoms involving urinary system (ICD–
9–CM code 788).
(10) fracture of neck of femur (ICD–9–CM
code 820).
(d) DETERMINATION
OF AGENCY-SPECIFIC PAY-
MENT AMOUNT.—
(1) CERTIFICATION
OF
QUANTITY
OF
QUALI-
FIED HOME HEALTH SERVICES FURNISHED.—
(A) IN GENERAL.—With respect to a fiscal
year, a home health agency may submit to the
Secretary a certification of the number of pa-
tients to whom the agency furnished qualified
home health services during the agency’s cost
reporting period beginning in that fiscal year.
(B) DEADLINE FOR SUBMISSION.—
(i) IN
GENERAL.—Such certification
shall be submitted to the Secretary during
the 30-day period beginning on the date
the agency submits to the Secretary a cost
report for the cost reporting period begin-
ning in such fiscal year.
(ii) TRANSITION RULE.—In the case
of an agency with a cost reporting period
beginning on or after October 1, 1997,
that ends before the date of the enactment
of this Act, with respect to such cost re-
porting period, the 30-day period under
clause (i) begins 60 days after the date of
the enactment of this Act.
(2) DETERMINATION
OF
AGGREGATE
QUALI-
FIED HOME HEALTH SERVICES FURNISHED.—From
data contained in certifications submitted under
paragraph (1) with respect to cost reporting periods
beginning in fiscal years 1998, 1999, and 2000, the
Secretary shall determine, with respect to a fiscal
year, the number of patients who have received
qualified home health services furnished by agencies
submitting such certifications for that fiscal year.
The Secretary shall make such determination by not
later than 120 days after all cost reports for that
fiscal year have been received.
(3) AGENCY-SPECIFIC PERCENTAGE OF AGGRE-
GATE AMOUNT.—For each home health agency sub-
mitting a certification under paragraph (1) for a fis-
cal year described in paragraph (2), the Secretary
shall determine an agency-specific percentage by di-
viding the number of patients certified by the home
health agency for that fiscal year by the national
total specified in paragraph (2) for that fiscal year.
(4) PAYMENT
AMOUNT.—The Secretary shall
pay for a fiscal year described in paragraph (2) to
a home health agency making the certification under
paragraph (1) an amount equal to the product of the
percentage determined under paragraph (3) and the
amount appropriated for such fiscal year under sub-
section (e).
(e) AUTHORIZATION OF APPROPRIATIONS.—There is
authorized to be appropriated from the Federal Hospital
Insurance Trust Fund (established under section 1817 of
the Social Security Act (42 U.S.C. 1395i)) for making ad-
ditional payments to home health agencies under this sec-
tion, $250,000,000 in each of the fiscal years 2000
through 2002.
(f) TERMINATION.—The Secretary shall not make ad-
ditional payments under this section for cost reporting pe-
riods, or portions of cost reporting periods, beginning on
or after the date of the implementation of the prospective
payment system for home health services under section
1895 of the Social Security Act (42 U.S.C. 1395fff).
(g) LIMITATION ON JUDICIAL REVIEW.—There shall
be no administrative or judicial review under section 1869
of the Social Security Act (42 U.S.C. 1395ff), section
1878 of such Act (42 U.S.C. 1395oo), or otherwise of any
action of the Secretary with respect to the determination
of an additional payment amount under this section.
SEC. 3. OVERPAYMENTS.
(a) 36-MONTH REPAYMENT PERIOD.—In the case of
an overpayment by the Secretary of Health and Human
Services to a home health agency for home health services
furnished during a cost reporting period beginning on or
after October 1, 1997, as a result of payment limitations
provided for under clause (v), (vi), or (viii) of section
1861(v)(1)(L) of the Social Security Act (42 U.S.C.
1395x(v)(1)(L)), the home health agency may elect to
repay the amount of such overpayment over a 36-month
period beginning on the date of notification of such over-
payment.
(b) INTEREST ON OVERPAYMENT AMOUNTS.—
(1) 36-MONTH GRACE PERIOD.—
(A) IN GENERAL.—In the case of an agen-
cy that makes an election under subsection (a),
no interest shall accrue on the outstanding bal-
ance of the amount of overpayment during such
36-month period.
(B) OVERDUE BALANCES.—In the case of
such an agency, interest shall accrue on any
outstanding balance of the amount of overpay-
ment after termination of such 36-month pe-
riod. Interest shall accrue under this subpara-
graph at the rate of interest charged by banks
for loans to their most favored commercial cus-
tomers, as published in the Wall Street Journal
on the Friday immediately following the date of
the enactment of this Act.
(2) OTHER AGENCIES.—In the case of an agen-
cy described in subsection (a) that does not make an
election under subsection (a), interest shall accrue
on the outstanding balance of the amount of over-
payment at the rate described in the second sentence
of paragraph (1)(B).
(c) TERMINATION.—No election under subsection (a)
may be made for cost reporting periods, or portions of cost
reporting periods, beginning on or after the date of the
implementation of the prospective payment system for
home health services under section 1895 of the Social Se-
curity Act (42 U.S.C. 1395fff).
(d) EFFECTIVE DATE.—The provisions of subsection
(a) shall take effect as if included in the enactment of the
Balanced Budget Act of 1997.
SEC. 4. UPDATE ON IMPLEMENTATION OF PROSPECTIVE
PAYMENT SYSTEM FOR HOME HEALTH AGEN-
CIES.
Not later than 90 days after the date of enactment
of this Act, and every 90 days thereafter until the prospec-
tive payment system for home health agencies (established
by section 1895 of the Social Security Act (42 U.S.C.
1395fff)) is implemented, the Secretary of Health and
Human Services shall meet with the staff of the appro-
priate committees of Congress to provide an informal up-
date regarding the progress of the Secretary in imple-
menting such payment system.
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