I
106TH CONGRESS
1ST SESSION
H. R. 2240
To amend title XVIII of the Social Security Act to revise payment amounts
to home health agencies under the Medicare Program, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 16, 1999
Mr. COYNE (for himself, Mr. ENGLISH, Mr. HILLIARD, Mr. LEVIN, Mr. SAND-
ERS, Mr. SAXTON, and Mr. SMITH of New Jersey) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means,
and in addition to the Committee on Commerce, for a period to be subse-
quently 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 revise
payment amounts to home health agencies 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. SHORT TITLE.
This Act may be cited as the ‘‘Medicare Home Health
Access Restoration Act of 1999’’.
SEC. 2. ADJUSTMENT TO PER BENEFICIARY LIMITS.
(a) INCREASE IN PAYMENT AMOUNT TO AGENCIES
WITH LIMITS UNDER THE NATIONAL AVERAGE.—Section
1861(v)(1)(L) of the Social Security Act (42 U.S.C.
1395x(v)(1)(L)), as amended by section 5101(a) of the
Tax and Trade Relief Extension Act of 1998 (Public Law
105–277), is amended—
(1) in clause (v)(I), by inserting ‘‘, clause (ix)’’
after ‘‘subject to clause (viii)(I)’’;
(2) in clause (viii)(I), by striking ‘‘during or
after fiscal year 1999’’ and inserting ‘‘during fiscal
year 1999’’;
(3) by redesignating clause (ix) as clause (xii);
and
(4) by inserting after clause (viii) the following
new clause:
‘‘(ix) In the case of a provider with a 12-month cost
reporting period ending in fiscal year 1994, if the limit
imposed under clause (v) (determined without regard to
this subclause) for a cost reporting period beginning after
fiscal year 1999 is less than the median described in
clause (vi)(I) (but determined as if any reference in clause
(v) to ‘98 percent’ were a reference to ‘100 percent’), the
payment limit for such provider and period shall be equal
to—
‘‘(I) for cost reporting periods beginning during
fiscal year 2000, 90 percent of such median;
‘‘(II) for cost reporting periods beginning dur-
ing fiscal year 2001, 95 percent of such median; and
‘‘(III) for cost reporting periods beginning dur-
ing or after fiscal year 2002, such median.
Each of the amounts specified in subclauses (I) through
(III) are such amounts as adjusted under clause (iii) to
reflect variations in wages among different areas.’’.
(b) ESTABLISHMENT
OF PER BENEFICIARY CAP;
WAIVER.—
(1) IN
GENERAL.—Section 1861(v)(1)(L) of
such Act (42 U.S.C. 1395x(v)(1)(L)), as amended in
subsection (a), is further amended—
(A) in clause (v)(I), by inserting ‘‘, and
clause (x)’’ after ‘‘clause (ix)’’; and
(B) by inserting after clause (ix), the fol-
lowing new clause:
‘‘(x) In the case of a provider with a 12-month cost
reporting period ending in fiscal year 1994, if the limit
imposed under clause (v) (determined without regard to
this subclause) for a cost reporting period beginning after
fiscal year 1999 exceeds the median described in clause
(vi)(I) (but determined as if any reference in clause (v)
to ‘98 percent’ were a reference to ‘100 percent’), the pay-
ment limit for such provider and period may not exceed—
‘‘(II) The Secretary shall establish such criteria as
is required for payment under this clause, including a de-
scription of the type of patient, patient condition, unusual
variations, and home health service that qualifies for such
payment.
‘‘(III) In making determinations under subclause (I),
the Secretary shall use data from the cost report, or from
other data collected by the Secretary, of the provider for
such year.
‘‘(IV) A provider may make an application for pay-
ment under this clause for a fiscal year no earlier than
the end of the provider’s cost reporting period beginning
in such fiscal year.
‘‘(V) In the case of an application for payment under
this clause that is approved by the Secretary, a provider
may elect to receive payment on a quarterly basis.’’.
(2) EFFECTIVE DATE.—The amendment made
by subsection (a) takes effect six months after the
date of the enactment of this Act, and applies with
respect to applications by home health agencies for
payment of reasonable costs for outliers for cost re-
porting periods ending on or after such date.
(d) REPORTS TO CONGRESS.—
(1) INITIAL REPORT.—Not later than one year
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall submit
to Congress a report describing the effect of the spe-
cial payment provisions provided for under the sec-
ond sentence of clause (x) and under clause (xi) of
section 1861(v)(1)(L) of the Social Security Act (42
U.S.C. 1395x(v)(1)(L)). Such report shall include
information with respect to the number of home
health agencies that requested payment under such
provisions and the number of such agencies that re-
ceived payment under such provisions.
(2) FINAL REPORT.—Not later than three years
after the date of the enactment of this Act, the Sec-
retary shall submit to Congress a report that up-
dates the report submitted under paragraph (1), in-
cluding additional information with respect to the ill-
nesses, and the characteristics of such illnesses, of
the patients for whom payment under such special
provisions was requested, and the characteristics of
the home health agencies furnishing home health
services to such patients for such illnesses.
SEC. 3. REVISION OF PER VISIT LIMITS.
Section 1861(v)(1)(L)(i) of the Social Security Act
(42 U.S.C. 1395x(v)(1)(L)(i)), as amended by section
5101(b) of the Tax and Trade Relief Extension Act of
1998 (Public Law 105–277), is amended—
(1) in subclause (IV), by striking ‘‘or’’;
(2) in subclause (V)—
(A) by inserting ‘‘and before October 1,
1999,’’ after ‘‘October 1, 1998,’’; 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, 1999, 110 percent of such me-
dian.’’.
SEC. 4. ELIMINATION OF CONTINGENT 15 PERCENT REDUC-
TION IN PAYMENT LIMITS UNDER THE IN-
TERIM PAYMENT SYSTEM.
Section 4603 of the Balanced Budget Act of 1997
(Public Law 105–33), as amended by section 5101(c)(3)
of the Tax and Trade Relief Extension Act of 1998 (Pub-
lic Law 105–277) (111 Stat. 471), is amended by striking
subsection (e).
SEC. 5. INFORMATIONAL MATERIALS FOR MEDICARE BENE-
FICIARIES WITH RESPECT TO HOME HEALTH
SERVICES.
(a) IN GENERAL.—The Secretary shall prepare a no-
tice of the rights of individuals entitled to benefits under
the medicare program (under title XVIII of the Social Se-
curity Act) to appeal a coverage determination with re-
spect to items and services furnished to such individual
under the program. In the case of such items and services
consisting of home health services furnished by a home
health agency, the home health agency shall furnish such
notice to such an individual upon discharge by the agency
of such individual from such services.
(b) INFORMATION FOR PHYSICIANS.—The Secretary
shall provide guidance for physicians contacted by affected
individuals to assist such individuals, including specific
guidance in the case of such individuals for whom home
health services are discontinued before the recommended
treatment is complete, but on behalf of whom payment
under the limits established under section 1861(v)(1)(L)
of the Social Security Act (42 U.S.C. 1395x(v)(1)(L)) has
been made in full by the Secretary to the home health
agency. The materials shall include telephone numbers
and such other information to enable the physician to seek
further assistance or clarification from individuals within
the Health Care Financing Administration with appro-
priate expertise.
(c) REQUESTS FOR ADDITIONAL RESOURCES.—The
Secretary may submit to Congress an estimate of addi-
tional resources required by the Health Care Financing
Administration to comply with the provisions of the sec-
tion. Any such estimate shall be included in the report
required under paragraph (1) of section 2(d).
(d) EFFECTIVE DATE.—By not later than six months
after the date of the enactment of this Act, the Secretary
shall begin distributing to home health agencies furnishing
home health services under the medicare program (under
title XVIII of the Social Security Act), and to physicians
furnishing services under such program, the information
prepared under this section.
SEC. 6. COMPTROLLER GENERAL STUDY ON MEDICARE
HOME HEALTH BENEFIT.
(a) STUDY.—
(1) COST OF SERVICES.—The Comptroller Gen-
eral of the United States shall conduct a study on
the relationship between the costs to the medicare
program (under title XVIII of the Social Security
Act) for home health services furnished by home
health agencies under the program, and the costs to
State and Federal government programs (including
the medicare program and the medicaid program
(under title XIX of such Act)) for services furnished
by rehabilitation agencies, public health agencies,
clinics, comprehensive outpatient rehabilitation fa-
cilities, skilled nursing facilities under the medicare
program, and for long-term care services furnished
under the medicaid program (under title XIX of
such Act).
(2) DETERMINATION OF SAVING OVERALL TO
MEDICARE
PROGRAM.—The Comptroller General
shall also determine whether providing home health
services as a benefit under the medicare program
has resulted in lower costs overall to the Federal
government.
(b) REPORT.—Not later than 18 months after the
date of the enactment of this Act, the Comptroller General
shall submit to Congress a report describing the results
of the study conducted under subsection (a).
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