I 
111TH CONGRESS 
1ST SESSION H. R. 3495 
To amend title XVIII of the Social Security Act to ensure access to quality 
home health services for all Americans, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 31, 2009 
Ms. KAPTUR introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to ensure 
access to quality home health services for all Americans, 
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. SHORT TITLE; PURPOSE. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Preserving Equitable Access to Community-based Home 
Health (PEACH) Act of 2009’’. 
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(b) PURPOSE.—It is the purpose of this Act to pre-
serve access to home health services for all Americans, re-
gardless of their ability to pay or their severity of illness. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) The Medicare home health benefit is vulner-
able to agency selection of the most profitable bene-
ficiaries and avoidance of the most complex and 
costly beneficiaries. 
(2) Such ‘‘cherry picking’’ by some home health 
agencies compromises access to care for the most 
complex, highest risk beneficiaries. 
(3) The Government Accountability Office has 
reported that hospital discharge planners have dif-
ficulty placing more than 10 percent of eligible pa-
tients in home health due to their extensive care 
needs. 
(4) Proposals to reduce Medicare payments to 
home health agencies (in response to large aggregate 
margins across all home health agencies) may under-
mine the financial viability of mission-driven and 
non-profit home health agencies, which often have 
low to negative margins, while allowing high-margin 
agencies to remain in operation. 
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SEC. 3. SUPPLEMENTAL PAYMENTS FOR PEACH AGENCIES. 
(a) IN GENERAL.—There shall be established a fund 
(to be known as the ‘‘PEACH fund’’) from which home 
health agencies meeting specified criteria shall be paid 
supplemental amounts in addition to their statutory pay-
ment amounts under title XVIII of the Social Security 
Act. Is this to be a trust fund? Where is this fund to be 
established? Who adminsters it? What are the sources of 
funding that goes into the fund? What are the allowed 
uses of such funding? 
(b) PEACH PROGRAM.—Title XVIII of the Social Se-
curity Act is amended by inserting after section 1895 the 
following new section: 
‘‘SUPPLEMENTAL PAYMENTS FOR PEACH AGENCIES 
‘‘SEC. 1895A. (a) DESIGNATION.— 
‘‘(1) IN GENERAL.—The Secretary shall des-
ignate as a ‘PEACH agency’ any home health agen-
cy that meets the criteria under paragraph (2). 
‘‘(2) CRITERIA.—The Secretary may not des-
ignate a home health agency as a PEACH agency 
unless the home health agency meets the following 
criteria: 
‘‘(A) The home health agency is certified 
for participation under this title. 
‘‘(B) The home health agency offers— 
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‘‘(i) the complete range of home 
health services as defined under section 
1861(m) of this title; 
‘‘(ii) the complete range of home 
health services on a 24 hours per day, 7 
days per week on-call basis; and 
‘‘(iii) its services to all eligible bene-
ficiaries or enrollees under this title and/or 
title XIX, and uninsured individuals up to 
its service capacity, regardless of their abil-
ity to pay or the complexity or intensity of 
care they require. 
‘‘(C) The home health agency provides 
charity care in an amount greater than or equal 
to 1 percent of its total revenue. 
‘‘(D) The home health agency agrees that 
the Secretary may, by statistical or other 
means, verify on an annual basis that the agen-
cy meets the criteria defined in this paragraph, 
and that the agency will be subject to disquali-
fication from the PEACH program if such cri-
teria are not met. 
‘‘(b) SUPPLEMENTAL PAYMENTS.— 
‘‘(1) IN GENERAL.—Subject to the availability 
of funds under subsection (c), the Secretary shall 
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make supplemental payments to PEACH agencies 
based on information submitted by the agency on an 
additional schedule in the Medicare cost report. 
‘‘(2) COST
REPORTING.—The Secretary shall 
implement an additional schedule, as a component of 
the cost reporting process, on which home health 
agencies may report information the Secretary 
deems necessary for designation and payment as a 
PEACH agency. 
‘‘(3) AMOUNT AND TIMING FOR FIRST YEAR AS 
PEACH AGENCY.— 
‘‘(A) The supplemental payment made to a 
home health agency for the first year in which 
such agency is designated a PEACH agency 
under this section shall be equal to its shortfall 
in that year, defined as the sum of— 
‘‘(i) the aggregate reasonable cost of 
home health services delivered under parts 
A and B of this title by the PEACH agen-
cy for such year, less the aggregate pay-
ments received by the PEACH agency pur-
suant to section 1895; 
‘‘(ii) the aggregate actual costs of 
home health and home and community 
based services delivered by the agency 
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under sections 1905(a)(7), 1905(a)(22), 
and 1915(c) through (e) of title XIX for 
such year, less the aggregate payments re-
ceived by the PEACH agency for such 
services under that title; and 
‘‘(iii) the aggregate cost of uncompen-
sated home health services delivered by the 
PEACH agency for such year. 
‘‘(B) The supplemental payment under 
subparagraph (A) shall be paid within 90 days 
of receipt of the annual cost report by the Sec-
retary. 
‘‘(4) AMOUNT AND TIMING FOR SUBSEQUENT 
YEARS.—For each year after the first year in which 
a home health agency is designated a PEACH agen-
cy, a PEACH agency shall receive interim supple-
mental payments based on— 
‘‘(A) the intervals at which the agency sub-
mits cost reports; and 
‘‘(B) the estimated shortfall, as defined in 
subparagraph (3)(A), for the year or interval in 
question. 
‘‘(c) FUNDING.—Supplemental payments under this 
section shall be— 
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‘‘(1) paid from the PEACH fund, which shall 
be capped at $500,000,000 annually and shall be 
administered by the Secretary; and 
‘‘(2) paid to PEACH agencies— 
‘‘(A) pursuant to subsection (b); or 
‘‘(B) if the PEACH fund is insufficient to 
cover all the supplemental payments that should 
be paid under subsection (b), in proportion to 
each agency’s shortfall relative to the aggregate 
shortfall of all PEACH agencies for the year in 
question. 
In any year in which the Secretary determines that 
the PEACH fund will not cover the aggregate esti-
mated shortfall of all PEACH agencies, the Sec-
retary shall make a preliminary supplemental pay-
ment to each PEACH agency within 90 days of re-
ceipt of its annual cost report and, if funds remain, 
an additional supplemental payment after all 
PEACH agency cost reports have been received. 
‘‘(d) DEFINITIONS.—For purposes of this section— 
‘‘(1) the term ‘charity care’ means home health 
services that are provided to an individual who is— 
‘‘(A) not eligible for payment under this 
title, under title XIX, or by any other third- 
party payer; and 
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‘‘(B) unable to pay any portion of the full 
cost of care, including any amount subsidized 
or otherwise discounted due to an individual’s 
inability to pay; and 
‘‘(2) the term ‘uncompensated care’ means 
home health services provided to an individual by a 
home health agency with the knowledge that the in-
dividual will be financially unable to pay for the 
services.’’. 
(c) CONFORMING AMENDMENT.—Section 1895(a) of 
the Social Security Act is amended by inserting before the 
period at the end the following: ‘‘and the provisions of sec-
tion 1895A’’. 
SEC. 4. REGULATIONS. 
The Secretary shall issue such regulations as are nec-
essary and appropriate for the implementation of the pro-
visions of this Act. 
SEC. 5. AUTHORIZATION OF APPROPRIATIONS. 
There is authorized for appropriation $500,000,000 
for each fiscal year beginning with fiscal year 2010 for 
purposes of carrying out the purposes of this Act. Is there 
anything this funds other than the PEACH fund? Should 
this go into the provision creating that fund? 
Æ 
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