SEC. 2. PROTECTING ACCESS TO MEDICARE HOME HEALTH 
SERVICES. 
(a) IN GENERAL.—Section 1895(b)(3) of the Social 
Security Act (42 U.S.C. 1395fff(b)(3)) is amended— 
(1) in subparagraph (B)(iv), by adding at the 
end the following: ‘‘Such adjustment shall not be 
made with respect to home health services for pay-
ment in 2008 and in making such an adjustment 
with respect to home health services for payment in 
a subsequent year, the Secretary shall evaluate 
changes in case mix using standards developed by 
the Secretary consistent with the processes described 
in subparagraph (D)(i) and taking into account the 
criteria described in subparagraph (D)(ii).’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) PROCESSES
AND
CRITERIA
FOR 
EVALUATING CHANGES IN CASE MIX.—For pur-
poses of subparagraph (B)(iv)— 
‘‘(i) PROCESSES.—The processes de-
scribed in this clause are the following: 
‘‘(I) In developing standards re-
ferred to in such subparagraph, the 
Secretary shall convene a Technical 
Advisory Group consisting of stake-
holders, including individuals and or-
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ganizations representing the interests 
of Medicare beneficiaries, the National 
Association for Home Care & Hospice, 
and the Visiting Nurse Associations of 
America, health care academia, and 
health care professionals, in equal 
numbers from each and limited to 
parties without an existing contractual 
relationship with the Secretary, to ad-
vise the Secretary concerning the es-
tablishment of such standards in 
order to distinguish between real 
changes in case mix and changes in 
coding or classification of different 
units of services that do not reflect 
real changes in case mix. The Tech-
nical Advisory Group shall be given 
the opportunity to review and com-
ment on any proposed rulemaking or 
final determination by the Secretary 
on such standards prior to such rule-
making or determination. 
‘‘(II) If the Secretary engages an 
outside contractor to participate in 
the evaluation of case mix changes de-
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scribed in subclause (I), the Secretary 
shall only utilize a contractor that has 
not previously participated in the de-
sign and establishment of the case 
mix adjustment factors under sub-
paragraph (B). 
‘‘(III) If the Secretary deter-
mines that any increase in case mix 
relates to changes in the volume or 
nature of services provided to home 
health services patients, the Secretary 
shall evaluate that increase through 
actual review of claims and services 
and shall not use any proxy or surro-
gate for determining whether the 
change in volume or nature of services 
is reasonable and necessary. 
‘‘(IV) The Secretary shall estab-
lish the standards referred to in sub-
clause (I) by regulation. 
‘‘(V) With respect to establish-
ment of such standards, the Secretary 
shall make public all data, reports, 
and supporting materials, including 
any comments by the Technical Advi-
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sory Group pursuant to subclause (I), 
regarding the standards at the time of 
notice of such standards. 
‘‘(ii) 
CRITERIA.—The 
criteria 
de-
scribed in this clause are the following: 
‘‘(I) The impact of changes in 
the program under this title that may 
affect the characteristics of individ-
uals receiving home health services. 
‘‘(II) The impact of changes in 
the provision of health care services 
by providers of services other than 
home health agencies. 
‘‘(III) Distinctions in the charac-
teristics of individuals initiating home 
health services from the community 
and institutional care settings. 
‘‘(IV) Whether any changes in 
coding resulted in a change in expend-
itures 
overall 
annually 
and 
dis-
regarding changes in coding that do 
not have an overall expenditure im-
pact. 
‘‘(V) Any other factors deter-
mined appropriate by the Secretary in 
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consultation with the Technical Advi-
sory Group under clause (i)(I).’’. 
(b) VOIDING
OF PROPOSED CASE MIX ADJUST-
MENT.—The Secretary of Health and Human Services 
shall not take any action to implement or otherwise carry 
out provisions contained in the final rule published on Au-
gust 29, 2007, on pages 49762–49945 of volume 72 of 
the Federal Register, insofar as such provisions propose 
to make a case mix adjustment to the standardized pay-
ment amounts under the prospective payment system for 
home health services under section 1895 of the Social Se-
curity Act (42 U.S.C. 1395fff) to account for changes in 
coding that were not related to an underlying change in 
patient health status. The Secretary shall republish any 
rates specified in such rule to take into account the appli-
cation of the previous sentence. The Secretary shall only 
institute an adjustment under subparagraph (B)(iv) of 
such section in compliance with subparagraph (D) of such 
section, as added by subsection (a)(2). 
Æ 
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