I
105TH CONGRESS
2D SESSION
H. R. 4567
To amend title XVIII of the Social Security Act to make revisions in the
per beneficiary and per visit payment limits on payment for health
services under the Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 15, 1998
Mr. THOMAS (for himself and Mr. MCGOVERN) introduced the following bill;
which was referred to the Committee on Way and Means, and in addition
to the Committee on Commerce, for a period to be subsequently deter-
mined 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 make
revisions in the per beneficiary and per visit payment
limits on payment for health services 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 ‘‘Medicare Home Health
Care Interim Payment System Refinement Act of 1998’’.
SEC. 2. INCREASE IN PER BENEFICIARY LIMITS AND PER
VISIT PAYMENT LIMITS FOR PAYMENT FOR
HOME HEALTH SERVICES UNDER THE MEDI-
CARE PROGRAM.
(a) INCREASE IN PER BENEFICIARY LIMITS.—
(1) IN GENERAL.—Section 1861(v)(1)(L) of the
Social Security Act (42 U.S.C. 1395x(v)(1)(L)) is
amended—
(A) in the first sentence of clause (v), by
inserting ‘‘subject to clause (viii)(I),’’ before
‘‘the Secretary’’;
(B) in clause (vi)(I), by inserting ‘‘subject
to clause (viii)(II)’’ after ‘‘fiscal year 1994’’;
and
(C) by adding at the end the following new
clause:
‘‘(viii)(I) In no case shall the limit imposed under
clause (v) for cost reporting periods beginning during fis-
cal year 1999 be less than the average of the limit other-
wise imposed under such clause and the median described
in clause (vi)(I) (but determined as if any reference in
clause (v) to ‘98 percent’ were a reference to ‘100 per-
cent’).
‘‘(II) Subject to subclause (III), for cost reporting pe-
riods beginning during or after fiscal year 1999, in no case
shall the limit imposed under clause (vi)(I) be less than
the median described in such clause (determined as if any
reference in clause (v) to ‘98 percent’ were a reference
to ‘100 percent’.
‘‘(III) In the case of new home health agency for
which the first cost reporting period begins during or after
fiscal year 1999, with respect to such cost reporting period
the limitation applied under clause (vi)(I) (but only with
respect to such provider) shall be equal to 75 percent of
the median described in subclause (II) of this clause.
‘‘(IV) The limits computed under subclauses (I)
through (III) are subject to adjustment under clause (iii)
to reflect variations in wages among different areas.’’.
(2) EXCLUSION OF ADDITIONAL PART B COSTS
FROM DETERMINATION OF PART B MONTHLY PRE-
MIUM.—Section 1839 of the Social Security Act (42
U.S.C. 1395r) is amended—
(A) in subsection (a)(3), by striking ‘‘in
subsection (e)’’ and inserting ‘‘in subsections
(e) and (g)’’, and
(B) by adding at the end the following new
subsection:
‘‘(g) In estimating the benefits and administrative
costs which will be payable from the Federal Supple-
mentary Medical Insurance Trust Fund for a year for pur-
poses of determining the monthly premium rate under
subsection (a)(3), the Secretary shall exclude an estimate
of any benefits and administrative costs attributable to the
application of section 1861(v)(1)(L)(viii), but only to the
extent payment for home health services under this title
is not being made under section 1895 (relating to prospec-
tive payment for home health services).’’.
(b) REVISION
OF
PER
VISIT
LIMITS.—Section
1861(v)(1)(L)(i) 
of 
such 
Act 
(42 
U.S.C.
1395x(v)(1)(L)(i)) is amended—
(1) in subclause (III), by striking ‘‘or’’;
(2) in subclause (IV)—
(A) by inserting ‘‘and before October 1,
1998,’’ after ‘‘October 1, 1997,’’; 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, 1998, 108 percent of such me-
dian.’’.
(c) REPORTS
ON SUMMARY
OF RESEARCH CON-
DUCTED BY THE SECRETARY ON THE SYSTEM.—By not
later than January 1, 1999, the Secretary of Health and
Human Services shall submit to Congress a report on the
following matters:
(1) RESEARCH.—A description of any research
paid for by the Secretary on the development of a
prospective payment system for home health services
furnished under the Medicare care program under
title XVIII of the Social Security Act, and a sum-
mary of the results of such research.
(2) SCHEDULE FOR IMPLEMENTATION OF SYS-
TEM.—The Secretary’s schedule for the implementa-
tion of the prospective payment system for home
health services under section 1895 of the Social Se-
curity Act (42 U.S.C. 1395fff).
(3) ALTERNATIVE TO 15 PERCENT REDUCTION
IN
LIMITS.—The Secretary’s recommendations for
one or more alternative means to provide for savings
equivalent to the savings estimated to be made by
the mandatory 15 percent reduction in payment lim-
its for such home health services for fiscal year 2000
under section 1895(b)(3)(A) of the Social Security
Act (42 U.S.C. 1395fff(b)(3)(A)), or, in the case the
Secretary does not establish and implement such
prospective payment system, under section 4603(e)
of the Balanced Budget Act of 1997. The Secretary
shall include a statement from the Chief Actuary of
the Health Care Financing Administration of the
amount of a per visit copayment that would be re-
quired to provide for such savings (based upon dif-
ferent caps on the aggregate amount of such copay-
ments for any person for a year).
(c) MEDPAC REPORTS.—
(1) REVIEW
OF
SECRETARY’S
REPORT.—Not
later than 60 days after the date the Secretary of
Health and Human Services submits to Congress
the report under subsection (b), the Medicare Pay-
ment Advisory Commission (established under sec-
tion 1805 of the Social Security Act (42 U.S.C.
1395b–6)) shall submit to Congress a report describ-
ing the Commission’s analysis of the Secretary’s re-
port, and shall include the Commission’s rec-
ommendations with respect to the matters contained
in such report.
(2) ANNUAL REPORT.—The Commission shall
include in its annual report to Congress for June
1999 an analysis of whether changes in law made by
the Balanced Budget Act of 1997, as modified by
the amendments made by this section, and this sec-
tion with respect to payments for home health serv-
ices furnished under the Medicare program under
title XVIII of the Social Security Act impede access
to such services by individuals entitled to benefits
under such program.
(d) GAO AUDIT OF RESEARCH EXPENDITURES.—
The Comptroller General of the United States shall con-
duct an audit of sums obligated or expended by the Health
Care Financing Administration for the research described
in subsection (b)(1), and of the data, reports, proposals,
or other information provided by such research.
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