I 
118TH CONGRESS 
1ST SESSION H. R. 5159 
To amend title XVIII of the Social Security Act to ensure stability in 
payments to home health agencies under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
AUGUST 4, 2023 
Ms. SEWELL (for herself and Mr. SMITH of Nebraska) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend title XVIII of the Social Security Act to ensure 
stability in payments to home health agencies under the 
Medicare program. 
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 ‘‘Preserving Access to 
Home Health Act of 2023’’. 
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SEC. 2. ENSURING STABILITY IN PAYMENTS TO HOME 
HEALTH AGENCIES. 
(a) REPEAL OF PERMANENT AND TEMPORARY AD-
JUSTMENTS.—Section 1895(b)(3) of the Social Security 
Act (42 U.S.C. 1395fff(b)(3)) is amended by striking sub-
paragraph (D). 
(b) EFFECTIVE DATE; IMPLEMENTATION.— 
(1) EFFECTIVE DATE.—The amendment made 
by subsection (a) shall take effect as if included in 
the enactment of the Bipartisan Budget Act of 2018 
(Public Law 115–123). 
(2) 
IMPLEMENTATION.—The 
Secretary 
of 
Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) shall implement such section 
1895(b)(3) for 2024 and subsequent years as if the 
amendment made by section 51001(a)(2)(B) of divi-
sion E of the Bipartisan Budget Act of 2018 (Public 
Law 115–123) (adding such subparagraph (D)) had 
not been made. 
(c) CONSTRUCTION.—Nothing in this section shall be 
construed as signifying congressional approval or dis-
approval of the methodology promulgated by the Secretary 
to implement section 1895(b)(3)(D) of the Social Security 
Act in the final rule entitled, ‘‘Medicare Program; Cal-
endar Year (CY) 2023 Home Health Prospective Payment 
System Rate Update; Home Health Quality Reporting 
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Program Requirements; Home Health Value-Based Pur-
chasing Expanded Model Requirements; and Home Infu-
sion Therapy Services Requirements’’ published in the 
Federal Register on November 4, 2022 (87 Fed. Reg. 
66790). 
SEC. 3. INTERACTION OF MEDICARE PAYMENT POLICIES 
WITH HEALTH CARE DELIVERY GENERALLY. 
Section 1805(b)(2)(C) of the Social Security Act (42 
U.S.C. 1395b–6(b)(2)(C)) is amended— 
(1) by striking ‘‘GENERALLY.—Specifically,’’ 
and inserting ‘‘GENERALLY.— 
‘‘(i) IN GENERAL.—Specifically,’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) 
SPECIAL
RULE
FOR
HOME 
HEALTH AGENCIES.— 
‘‘(I) IN
GENERAL.—When con-
ducting the review of home health 
agency financial performance and its 
impact on access to care under the 
original fee-for-service system, the 
Commission shall— 
‘‘(aa) review and report on 
aggregate trends in spending, 
utilization, and financial perform-
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ance under the Medicare Advan-
tage program, the Medicaid pro-
gram under title XIX (both fee- 
for-service and managed care 
payment models), and other pay-
ers for home health agency serv-
ices; 
‘‘(bb) evaluate and consider 
the impact of all payers on access 
to 
care 
for 
Medicare 
bene-
ficiaries; and 
‘‘(cc) comprehensively dis-
close the methodologies used to 
evaluate 
and 
calculate 
home 
health agency margins under this 
title and all other payers, includ-
ing the process for developing the 
data used. 
Where appropriate, the Commission 
shall conduct such reviews in con-
sultation with the Medicaid and CHIP 
Payment and Access Commission es-
tablished under section 1900. 
‘‘(II) MEDICARE HOME HEALTH 
COST
REPORT
AMENDMENTS.—For 
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cost reporting periods beginning in 
2025 and subsequent years, the Sec-
retary shall have in effect an amended 
Medicare home health cost report that 
collects data on visit utilization and 
total payments by payer source, in-
cluding original fee-for-service pay-
ments, Medicare Advantage, the Med-
icaid program under title XIX (both 
fee-for-service and managed care pay-
ment models), and other payers. The 
Secretary shall make such amended 
cost reports available to the Commis-
sion in the form and manner nec-
essary to conduct the analysis de-
scribed in subclause (I). 
‘‘(III) FINANCIAL
DATA.—Prior 
to the availability of cost report data 
as described in subclause (II), the 
Commission shall utilize data on cost 
and revenues from sources it deems as 
reliable and valid for purposes of con-
ducting the analysis described in sub-
clause (I).’’. 
Æ 
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