‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding provisions of this subsection, the Sec-
retary shall establish a home health agency 
value-based purchasing program (in this sub-
section referred to as the ‘HHA VBP Pro-
gram’) under which value-based incentive pay-
ments are made in a year to home health agen-
cies. 
‘‘(B) PROGRAM TO BEGIN IN 2019.—The 
HHA VBP Program shall apply to payments 
for episodes of home health services beginning 
on or after January 1, 2019. 
‘‘(2) APPLICATION OF MEASURES.—— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary shall apply the meas-
ure specified under subsection (f)(2) for pur-
poses of the HHA VBP Program. 
‘‘(B) REPLACEMENT.—If the Secretary de-
termines that the application of such measure is 
not practicable and should be delayed and the 
Secretary notifies the Committee on Finance of 
the Senate and the Committees on Ways and 
Means and Energy and Commerce of the House 
of Representatives of the reasons for such delay 
in advance of implementing such delay, the Sec-
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retary may delay the application of such meas-
ure for a period of up to 1 year. For the period 
of any such delay, the measure specified under 
subsection (f)(1) shall apply for purposes of the 
HHA VBP Program instead of the measure 
specified under subsection (f)(2). 
‘‘(3) PERFORMANCE STANDARDS.— 
‘‘(A) 
ESTABLISHMENT.—The 
Secretary 
shall establish performance standards with re-
spect to the measure applied under paragraph 
(2) for a performance period for a year. 
‘‘(B) HIGHER OF ACHIEVEMENT AND IM-
PROVEMENT.—The performance standards es-
tablished under subparagraph (A) shall include 
levels of achievement and improvement. In cal-
culating the HHA performance score under 
paragraph (4), the Secretary shall use the high-
er of either improvement or achievement. 
‘‘(C) TIMING.—The Secretary shall estab-
lish and announce the performance standards 
established under subparagraph (A) not later 
than 60 days before the beginning of the per-
formance period for the year involved. 
‘‘(4) HHA PERFORMANCE SCORE.— 
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‘‘(A) IN
GENERAL.—The Secretary shall 
develop by regulation a methodology for assess-
ing the total performance of each home health 
agency based on performance standards estab-
lished under paragraph (3) with respect to the 
measure applied under paragraph (2). Using 
such methodology, the Secretary shall provide 
for an assessment (in this subsection referred to 
as the ‘HHA performance score’) for each home 
health agency for each such performance pe-
riod. 
‘‘(B) RANKING
OF
HHA
PERFORMANCE 
SCORES.—The Secretary shall, for the perform-
ance period for each year, rank the HHA per-
formance scores determined under subpara-
graph (A) from low to high. 
‘‘(5) BUDGET
NEUTRAL
WITHHOLDING.—The 
Secretary shall withhold from the payment rates 
made for each year (during the period beginning 
with 2019 and ending with 2024) for home health 
services under this section such withholding percent-
age as is necessary so that the enactment of the Se-
curing Access Via Excellence for Medicare Home 
Health Act of 2014 is estimated not to result in any 
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net change in payments made for such services 
under this title. 
‘‘(6) VALUE-BASED INCENTIVE PAYMENT PER-
CENTAGE.—The Secretary shall provide for a dis-
tribution of a portion of the amounts withheld under 
paragraph (5) for performance payments to home 
health agencies in a manner so as to ensure that— 
‘‘(A) the distribution (expressed as a per-
centage of such withheld amounts) is based on 
each agency’s HHA performance ranking under 
paragraph (4)(B) for the performance period 
for the year involved; 
‘‘(B) the application of all such percent-
ages in such year results in an appropriate dis-
tribution of value-based incentive payments 
under this subsection such that— 
‘‘(i) home health agencies with the 
highest rankings under paragraph (4)(B) 
receive the highest value-based incentive 
payment amounts under this subsection; 
‘‘(ii) home health agencies with the 
lowest rankings under paragraph (4)(B) 
receive the lowest value-based incentive 
payment amounts under this subsection; 
and 
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‘‘(iii) in the case of home health agen-
cies in the lowest 40 percent of the ranking 
under paragraph (4)(B), the payment rate 
under this subsection for services furnished 
by such facility during such year shall be 
less than the payment rate for such serv-
ices for such year that would otherwise 
apply without application of this sub-
section; and 
‘‘(C) the total amount of value-based in-
centive payments under this subsection for all 
home health agencies in such year shall be 
greater than or equal to 50 percent, but not 
greater than 70 percent, of the total amount of 
the payments withheld for such year under 
paragraph (5), as estimated by the Secretary. 
‘‘(7) ANNOUNCEMENT OF RESULT OF ADJUST-
MENTS.—Under the HHA VBP program, the Sec-
retary shall, not later than 60 days before a year in-
volved, inform each home health agency of the ad-
justments to payments to the agency for services 
furnished by the agency during the year under this 
subsection. 
‘‘(8) NO EFFECT IN SUBSEQUENT YEAR.—The 
value-based payment adjustments under this sub-
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section shall only apply with respect to the year in-
volved, and the Secretary shall not take into account 
such adjustment in making payments to a home 
health agency under this section in a subsequent 
year. 
‘‘(9) FUNDING FOR PROGRAM MANAGEMENT.— 
The Secretary shall provide for the one-time transfer 
from the Federal Supplementary Medical Insurance 
Trust Fund established under section 1841 to the 
Centers for Medicare & Medicaid Services Program 
Management Account of— 
‘‘(A) $2,000,000 for purposes of subsection 
(f); and 
‘‘(B) $10,000,000 for purposes of imple-
menting this subsection. 
Such funds shall remain available until expended.’’. 
(c) MEDPAC STUDY.—Not later than June 30, 
2021, the Medicare Payment Advisory Commission shall 
submit to Congress a report that reviews the progress of 
the home health value-based purchasing program estab-
lished under section 1895(g) of the Social Security Act, 
as added by subsection (b), and makes recommendations, 
as appropriate, on any improvements that should be made 
to such program. For purposes of the previous sentence, 
the Medicare Payment Advisory Commission shall con-
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