tem Rate Update and Proposed CY 2019 Case- 
Mix Adjustment Methodology Refinements; 
Home Health Value-Based Purchasing Model; 
and Home Health Quality Reporting Require-
ments’ (82 Fed. Reg. 35294 through 35332 
(July 28, 2017) (herein referred to as ‘the 2018 
Home Health Proposed Rule’)) and as such 
model may subsequently be revised through no-
tice and comment rulemaking. 
‘‘(B) CALCULATION OF BUDGET NEUTRAL 
PAYMENT AMOUNTS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall, subject to subparagraph (F), cal-
culate payment amounts under this sub-
section with respect to home health 30-day 
periods of care furnished in 2020 in a 
manner such that the estimated aggregate 
amount of expenditures under the prospec-
tive payment system under this subsection 
with application of this paragraph is equal 
to the estimated aggregate amount of ex-
penditures under this subsection without 
application of this paragraph. 
‘‘(ii) EXCLUSION
OF
ADJUSTMENTS 
FROM CALCULATION.—Adjustments under 
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paragraph (3) (including adjustments for 
case mix changes under clause (iv) of such 
paragraph) and paragraph (5) and sub-
paragraphs (E) and (F) shall not be in-
cluded in the calculation under clause (i). 
‘‘(C) LIMITING
SAVINGS
COMPARED
TO 
THE 2018 HOME HEALTH PROPOSED RULE.—In 
order to reduce the aggregate amount of sav-
ings under the home health groupings model 
compared to the estimated impacts in the 2018 
Home Health Proposed Rule, after calculating 
amounts in subparagraph (B), the Secretary 
shall reduce such 2020 amounts by 3.7 percent. 
‘‘(D) STANDARD
PROSPECTIVE
PAYMENT 
AMOUNTS FOR 2020 AND SUBSEQUENT YEARS.— 
‘‘(i) STANDARD
PROSPECTIVE
PAY-
MENT AMOUNTS.—The standard prospec-
tive payment amounts for home health 30- 
day periods of care beginning with 2020 
shall be the amounts reduced in subpara-
graph (C) subject to clauses (iv) and (v) of 
subparagraph (F). 
‘‘(ii) 
APPLICATION
OF
ADJUST-
MENTS.—Adjustments described in sub-
paragraph (B)(ii) (other than the adjust-
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ment described in subparagraph (E)) shall 
be applied to such standard prospective 
payment amounts. 
‘‘(E) TRANSITIONAL
ADJUSTMENTS
TO 
HOME HEALTH GROUPINGS MODEL.—In order 
to provide for a transition to the home health 
groupings model, the Secretary shall, after ap-
plication of adjustments described in subpara-
graph (D)(ii), increase payment amounts under 
clause (iii) as follows: 
‘‘(i) For 2020, the increase shall be 
1.5 percent. 
‘‘(ii) For 2021, the increase shall be 
1.0 percent. 
‘‘(iii) For 2022, the increase shall be 
0.5 percent. 
‘‘(F) PROVIDER
BEHAVIOR
ASSUMPTIONS 
AND RECONCILIATION.— 
‘‘(i) ASSUMPTIONS.—In calculating 
amounts under subparagraph (B)(i), the 
Secretary shall make assumptions about 
provider behavioral change that could 
occur as a result of implementation of the 
home health groupings model such as for 
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changes in the number of service units and 
changes in diagnosis codes billed. 
‘‘(ii) 
DESCRIPTION
OF
ASSUMP-
TIONS.—The Secretary shall provide a de-
scription of the assumptions made under 
clause (i) in the notice and comment rule-
making used to implement this paragraph. 
‘‘(iii) 
RECONCILIATION.—Not 
later 
than 2025, and in subsequent years as ap-
propriate, the Secretary shall determine 
the impact of differences between actual 
and assumed behavior on estimated aggre-
gate expenditures under this subsection. 
‘‘(iv) PERMANENT
ADJUSTMENTS.— 
The Secretary shall, at a time and in a 
manner determined appropriate, provide 
for one or more permanent increases or de-
creases to the standard prospective pay-
ment amounts for applicable years, on a 
prospective basis, to account for the deter-
mination under clause (iii). 
‘‘(v) TEMPORARY ADJUSTMENTS FOR 
RETROSPECTIVE
BEHAVIOR.—The 
Sec-
retary shall, at a time and in a manner de-
termined appropriate, provide for one or 
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more temporary increases or decreases to 
the standard prospective payment amounts 
for applicable years, on a prospective basis, 
to account for the determination under 
clause (iii) with respect to years before the 
adjustment in clause (iv). 
‘‘(vi) OTHER
BEHAVIOR.—The Sec-
retary shall, at a time and in a manner de-
termined appropriate, apply permanent 
and temporary adjustments to adjust for 
increases in estimated aggregate expendi-
tures as a result of behavior responses not 
described in clause (ii). 
‘‘(G) CONTINUED APPLICATION OF PROVI-
SIONS.—Except as described in this paragraph, 
the provisions of this section shall continue to 
apply.’’. 
(2) CONFORMING AMENDMENT.—Paragraph (2) 
of section 1895(b) of the Social Security Act (42 
U.S.C. 1395fff(b)(2)) is amended by striking ‘‘In’’ 
and inserting ‘‘Subject to paragraph (7)(A), in’’. 
(b) EXTENSION OF HOME HEALTH RURAL ADD- 
ON.—Section 421 of the Medicare Prescription Drug, Im-
provement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2283), as amended by section 5201(b) 
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of the Deficit Reduction Act of 2005 (Public Law 109– 
171; 120 Stat. 46), section 3131(c) of the Patient Protec-
tion and Affordable Care Act (Public Law 111–148; 124 
Stat. 428), and section 210 of the Medicare Access and 
CHIP Reauthorization Act of 2015 (Public Law 114–10; 
129 Stat. 87), is amended by striking ‘‘January 1, 2018’’ 
each place it appears and inserting ‘‘January 1, 2023’’. 
(c) REPORTS.— 
(1) INTERIM REPORT.—Not later than March 
15, 2022, the Medicare Payment Advisory Commis-
sion shall submit to Congress an interim report on 
the modifications made by section 1895(b)(7) of the 
Social Security Act (42 U.S.C. 1395fff(b)(7)), as 
added by subsection (a), and any unintended con-
sequences including— 
(A) behavioral changes that may occur due 
to lower reimbursement for Medication Manage-
ment, Training and Assessment; 
(B) behavioral changes that may occur due 
to higher reimbursement following hospitaliza-
tions; 
(C) use of statistically derived, versus ac-
tual, payment weights; 
(D) questionable encounters; 
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(E) use of both primary and secondary di-
agnosis codes for episode assignment; and 
(F) reducing reimbursement of behavioral 
health episodes, compared to the Home Health 
Resource Group model. 
(2) FINAL REPORT.—Not later than March 15, 
2026, MedPAC, the Medicare Payment Advisory 
Commission shall submit to Congress a final report 
on such modifications and any such consequences. 
Æ 
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