I
104TH CONGRESS
2D SESSION
H. R. 4229
To amend title XVIII of the Social Security Act to provide for prospective
payment for home health services under the Medicare program, and
for other purposes.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 27, 1996
Mrs. JOHNSON of Connecticut introduced the following bill; which was referred
to the Committee on Ways and Means, and in addition to the Committee
on Commerce, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
for prospective payment for home health services 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
Services Prospective Payment Amendments of 1996’’.
SEC. 2. PAYMENT FOR HOME HEALTH SERVICES.
(a) IN GENERAL.—Title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.), as amended by section 202
of Public Law 104–191, is amended by adding at the end
the following new section:
‘‘PAYMENT FOR HOME HEALTH SERVICES
‘‘SEC. 1894. (a) IN GENERAL.—Notwithstanding sec-
tion 1861(v), the Secretary shall provide for payments for
home health services in accordance with a prospective pay-
ment system as follows:
‘‘(1) PER
VISIT
PAYMENTS.—Subject to sub-
section (c), the Secretary shall make per visit pay-
ments to a home health agency in accordance with
this section for each type of home health service de-
scribed in paragraph (2) furnished to an individual
who at the time the service is furnished is under a
plan of care by the home health agency under this
title (without regard to whether or not the item or
service was furnished by the agency or by others
under arrangement with them made by the agency,
under any other contracting or consulting arrange-
ment, or otherwise).
‘‘(2) TYPES OF SERVICES.—The types of home
health services described in this paragraph are the
following:
‘‘(A) Part-time or intermittent nursing
care provided by or under the supervision of a
registered professional nurse.
‘‘(B) Physical therapy.
‘‘(C) Occupational therapy.
‘‘(D) Speech-language pathology services.
‘‘(E) Medical social services under the di-
rection of a physician.
‘‘(F) To the extent permitted in regula-
tions, part-time or intermittent services of a
home health aide who has successfully com-
pleted a training program approved by the Sec-
retary.
‘‘(b) ESTABLISHMENT
OF PER VISIT RATE
FOR
EACH TYPE OF ASSISTANCE.—
‘‘(1) IN GENERAL.—The Secretary shall, sub-
ject to paragraph (3), establish a per visit payment
rate for a home health agency in an area (which
shall be the same area used to determine the area
wage index applicable to hospitals under section
1886(d)(3)(E)) for each type of home health service
described in subsection (a)(2). Such rate shall be
equal to the national per visit payment rate deter-
mined under paragraph (2) for each such type, ex-
cept that the labor-related portion of such rate shall
be adjusted by the area wage index applicable under
section 1886(d)(3)(E) for the area in which the
agency is located (as determined without regard to
any reclassification of the area under section
1886(d)(8)(B) or a decision of the Medicare Geo-
graphic Classification Review Board or the Secretary
under section 1886(d)(10) for cost reporting periods
beginning after October 1, 1995).
‘‘(2) NATIONAL PER VISIT PAYMENT RATE.—
The national per visit payment rate for each type of
service described in subsection (a)(2)—
‘‘(A) for fiscal year 1997, is an amount
equal to the national average amount reim-
bursed per visit under this title to home health
agencies for such type of service (including
medical supplies) during the most recent 12-
month cost reporting period ending on or before
December 31, 1994, updated by the home
health market basket percentage increase for
each year before the date in such fiscal year in
which this section first applies; and
‘‘(B) for each subsequent fiscal year, is an
amount equal to the national per visit payment
rate in effect under this paragraph for the pre-
ceding fiscal year, increased by the home health
market basket percentage increase for such sub-
sequent fiscal year.
‘‘(3) PAYMENTS ABOVE PER VISIT RATES.—
centage increase’ means, with respect to a fiscal
year, a percentage (estimated by the Secretary be-
fore the beginning of the fiscal year) determined and
applied with respect to the types of home health
services described in subsection (a)(2) in the same
manner as the market basket percentage increase
under section 1886(b)(3)(B)(iii) is determined and
applied to inpatient hospital services for discharges
in the fiscal year.
‘‘(c) AGGREGATE LIMITS.—
‘‘(1) PHASE I AGGREGATE LIMIT.—
‘‘(A) IN GENERAL.—Before the end of the
second 12-month period beginning on the effec-
tive date of this section, except as provided in
paragraphs (3) and (4), a home health agency
may not receive aggregate per visit payments
under subsection (a) for such a 12-month pe-
riod in excess of an amount equal to the prod-
uct of—
‘‘(i) the number of unduplicated medi-
care beneficiaries receiving home health
services from the agency during the period;
and
‘‘(ii) the per patient limit determined
for such period.
‘‘(B) ESTABLISHMENT
OF
PER
PATIENT
LIMITS FOR INITIAL YEAR.—
‘‘(i) IN GENERAL.—For the initial 12-
month period, the per patient limit for an
agency is equal to the product of—
‘‘(I) the sum of 75 percent of the
updated per visit costs described in
clause (ii) for the agency and 25 per-
cent of the regional average described
in clause (iii) for the agency; and
‘‘(II) the average annual number
of medicare home health agency visits
per unduplicated medicare beneficiary
for fiscal year 1995.
‘‘(ii) UPDATED
PER
VISIT
COSTS.—
The updated per visit costs described in
this clause, for a home health agency for
a payment period, is the average per visit
reasonable costs for home health services
of the agency, calculated for the base year,
based on fiscal year 1994 cost per visit,
updated by the home health market basket
percentage increase through the payment
period involved.
‘‘(iii) REGIONAL
AVERAGE.—The re-
gional average described in this clause, for
a home health agency for a payment pe-
riod, is the average of the updated per visit
costs described in clause (ii) for the period
for home health agencies located in the
same census region in which the agency is
located.
‘‘(C) ESTABLISHMENT
OF
PER
PATIENT
LIMITS FOR SECOND YEAR.—For the second 12-
month period, the per patient limit for an agen-
cy is equal to the product of—
‘‘(i) the sum of—
‘‘(I) 50 percent of the updated
per visit costs described in subpara-
graph (B)(ii) for the agency for the
period, and
‘‘(II) 50 percent of the regional
average described in subparagraph
(B)(iii) for the agency for the period;
and
‘‘(ii) the average annual number of
medicare home health agency visits per
unduplicated medicare beneficiary for fiscal
year 1995.
‘‘(D) NEW
PROVIDERS
AND
PROVIDERS
WITHOUT BASE YEAR.—For a new home health
agency or a home health agency for which there
is no base year under subparagraph (B)(ii), the
per patient limit shall be equal to the mean of
these limits applied to home health agencies in
the same census region in which the agency is
located as determined by the Secretary. A home
health agency shall not be treated as a new
home health agency by reason of any corporate
restructuring or change of name.
‘‘(2) PHASE II AGGREGATE LIMITS.—
‘‘(A) IN GENERAL.—After the end of the
second 12-month period beginning on the effec-
tive date of this section and until the effective
date of any episodic prospective payment sys-
tem (including a system developed under sub-
section (h)) that is enacted by the Congress, ex-
cept as provided in paragraphs (3) and (4), a
home health agency may not receive aggregate
per visit payments under subsection (a) for a
12-month payment period in excess of an
amount equal to the sum of the following:
‘‘(i) The sum (for all case-mix cat-
egories) of the products (determined sepa-
rately for each such category) of—
‘‘(I) the total number of episodes
for the category for which the agency
receives payments during the payment
period, and
‘‘(II) the per episode limit deter-
mined under subparagraph (B) for
the category and payment year.
‘‘(ii) The product of—
‘‘(I) the number of unduplicated
medicare beneficiaries receiving home
health services from the agency be-
yond 120 days during the payment
year, and
‘‘(II) the per patient limit for
services provided beyond 120 days, as
specified in subparagraph (E).
‘‘(B) ESTABLISHMENT
OF
PER
EPISODE
LIMITS FOR FIRST 120 DAYS.—
‘‘(i) IN
GENERAL.—The per episode
limit under this subparagraph for a pay-
ment year for a case-mix category for the
area in which a home health agency is lo-
cated (which shall be the same area used
to determine the area wage index applica-
ble 
to 
hospitals 
under 
section
1886(d)(3)(E)) is equal to the product
of—
‘‘(I) the mean number of visits
for each type of home health service
described in subsection (a)(2) fur-
nished during an episode of such case-
mix category in such area during fis-
cal year 1995; and
‘‘(II) the per visit payment rate
established under subsection (b) for
such type of home health service for
the fiscal year for which the deter-
mination is being made.
‘‘(ii) DETERMINATION OF AREA.—In
the case of an area which the Secretary de-
termines has an insufficient number of
home health agencies to establish an ap-
propriate per episode limit under this sub-
paragraph, the Secretary may establish an
area other than the area used to determine
the area wage under section 1886(d)(3)(E)
for purposes of establishing an appropriate
per episode limit.
‘‘(C) CASE-MIX CATEGORY.—For purposes
of this paragraph, the term ‘case-mix category’
means each of the 18 case-mix categories estab-
lished under the Home Health Agency Prospec-
tive Payment Demonstration Project conducted
by the Health Care Financing Administration.
The Secretary may develop and apply a more
accurate methodology for determining case-mix
categories subject to prior public notice and
comment under section 553 of title 5, United
States Code.
‘‘(D) EPISODE.—
‘‘(i) IN
GENERAL.—For purposes of
this paragraph, the term ‘episode’ means
the continuous 120-day period that—
‘‘(I) begins on the date of an in-
dividual’s first visit for a type of home
health service described in subsection
(a)(2) for a case-mix category, and
‘‘(II) is immediately preceded by
a 45-day period in which the individ-
ual did not receive visits for a type of
home health service described in sub-
section (a)(2).
‘‘(ii) PRORATION OF EPISODE LIMIT
SPANNING
PAYMENT
YEARS.—The Sec-
retary shall provide for such rules as ap-
propriate to prorate episode limits under
this paragraph which begin during a pay-
ment year and end in a subsequent pay-
ment year.
‘‘(E) ESTABLISHMENT OF A PER PATIENT
ANNUAL LIMIT FOR SERVICES PROVIDED AFTER
120 DAYS.—
‘‘(i) IN
GENERAL.—The per patient
limit for services provided by a home
health agency after 120 days for a pay-
ment period is equal to the product of—
‘‘(I) the sum of 50 percent of the
updated per visit costs described in
paragraph (1)(B)(ii) for the agency
and year and 50 percent of the re-
gional average described in paragraph
(1)(B)(iii) for the agency and year;
and
‘‘(II) the average annual number
of medicare home health agency visits
over 120 days per unduplicated medi-
care beneficiary for fiscal year 1995.
‘‘(ii) NEW
PROVIDERS
AND
PROVID-
ERS WITHOUT BASE YEAR.—The provisions
of subparagraph (D) of paragraph (1)
shall apply with respect to clause (i)(I) in
the same manner as they apply to subpara-
graph (B)(ii) of paragraph (1).
‘‘(3) EXEMPTIONS AND EXCEPTIONS.—
‘‘(A) EXTRAORDINARY
COSTS.—The Sec-
retary shall provide for an exemption from, or
an exception and adjustment to, at the request
of the home health agency, the methods under
this subsection for determining payment limits
where events beyond the home health agency’s
control or extraordinary circumstances, includ-
ing the case mix of such home health agency,
create reasonable costs for a payment year
which exceed the applicable payment limits.
‘‘(B) OTHER
FACTORS.—The Secretary
may provide for such other exemptions from,
and exceptions and adjustments to, such meth-
ods, as the Secretary deems appropriate, as de-
termined by the Secretary.
‘‘(C) TIMELY DETERMINATION.—The Sec-
retary shall announce a decision on any request
for an exemption, exception, or adjustment
under this paragraph not later than 120 days
after receiving a completed application from the
home health agency for such exemption, excep-
tion, or adjustment, and shall include in such
decision a detailed explanation of the grounds
on which such request was approved or denied.
‘‘(D) LIMITATION.—The cumulative ex-
penditures for exemptions and exceptions under
this paragraph shall not exceed the cumulative
amount that would have been payable under
paragraph (4)(B) if the 10 percent limitation
under clause (ii) of such paragraph did not
apply.
‘‘(4) RECONCILIATION OF AMOUNTS.—
‘‘(A) PAYMENTS IN EXCESS OF LIMITS.—
If a home health agency has received aggregate
per visit payments under subsection (a) for a
fiscal year in excess of the amount determined
under paragraph (1) with respect to such home
health agency for such fiscal year, the Secretary
shall reduce payments under this section to the
home health agency in the following fiscal year
in such manner as the Secretary considers ap-
propriate (including on an installment basis) to
recapture the amount of such excess.
‘‘(B) SHARE OF SAVINGS.—
‘‘(i) COMPUTATION.—If a home health
agency has received aggregate per visit
payments under subsection (a) for a pay-
ment year in an amount less than the limit
determined under paragraph (1) or (2) (as
applicable) with respect to such home
health agency for such payment year and,
with respect only to paragraphs (1) and
(2)(E), the home health agency has an av-
erage payment per unduplicated medicare
beneficiary at or below 125 percent of the
regional average (described in paragraph
(1)(B)(iii) or (2)(E)(iii), respectively), sub-
ject to clause (ii), the Secretary shall pay
such home health agency a payment equal
to 50 percent of the difference between the
aggregate payment and each applicable
limit under paragraphs (1), (2)(B), or
(2)(E).
‘‘(ii) LIMITATION.—In no case shall
payments under clause (i) for an agency
for a year exceed 10 percent of the aggre-
gate per visit payments made to the agency
for the year.
‘‘(iii) INSTALLMENT PAYMENTS.—The
Secretary may make the payments to a
home health agency under clause (i) during
a payment year on an installment basis
based on the estimated payment that the
agency would be eligible to receive with re-
spect to such payment year.
‘‘(d) MEDICAL REVIEW PROCESS.—The Secretary
shall implement a medical review process for the system
of payments described in this section that shall provide
an assessment of the pattern of care furnished to individ-
uals receiving home health services for which payments are
made under this section to ensure that such individuals
receive appropriate home health services.
‘‘(e) ADJUSTMENTS.—
‘‘(1) IN GENERAL.—The Secretary shall provide
for appropriate adjustments to payments to a home
health agency under this section to ensure that the
agency does not engage in the following for the pur-
poses of circumventing the limits:
‘‘(A) Discharging patients to another home
health agency or similar provider.
‘‘(B) Altering corporate structure or name
to avoid being subject to this section or for the
purpose of increasing payments under this title.
‘‘(2) TRACKING
OF
PATIENTS
THAT
SWITCH
HOME HEALTH AGENCIES.—
‘‘(A) DEVELOPMENT
OF
SYSTEM.—The
Secretary shall develop a system that tracks
home health patients that receive home health
services described in subsection (a)(2) from
more than 1 home health agency.
‘‘(B) ADJUSTMENT OF LIMITS.—The Sec-
retary shall adjust limits under this section to
each home health agency that furnishes an indi-
vidual with a type of home health service de-
scribed in subsection (a)(2) to ensure that ag-
gregate payments on behalf of such individual
during such episode do not exceed the amount
that would be paid under this section if the in-
dividual received such services from a single
home health agency.
‘‘(3) MONITORING LOW-COST CASES.—
‘‘(A) IN
GENERAL.—The Secretary shall
develop and implement a system designed to
monitor significant changes in the percentage
distribution of low-cost and high-cost patients
for which home health services are furnished by
a home health agency over such percentage dis-
tribution determined for the agency under sub-
paragraph (B).
‘‘(B) DISTRIBUTION.—The Secretary shall
profile home health service patients to deter-
mine the distribution of patients for the pur-
pose of determining regional and national
trends.
‘‘(C) 
LOW-COST
AND
HIGH-COST
PA-
TIENTS.—For purposes of this paragraph, the
Secretary shall define a low-cost and high-cost
patient in a manner that provides that a home
health agency has an incentive to be cost effi-
cient in delivering home health services and
that the volume of such services does not in-
crease as a result of factors other than patient
needs.
‘‘(D) REPORT ON ACCESS.—The Secretary
shall report to Congress on an annual basis
findings and recommendations for ensuring ac-
cess to appropriate home health services.
‘‘(f) SPECIAL RULE FOR CHRISTIAN SCIENCE PRO-
VIDERS.—
‘‘(1) PAYMENT
PERMITTED
FOR
SERVICES.—
Notwithstanding any other provision of this title,
payment shall be made under this title for home
health services furnished by Christian Science pro-
viders who meet applicable requirements of the First
Church of Christ, Scientist, Boston, Massachusetts,
and are certified for purposes of this title under cri-
teria established by the Secretary, in accordance
with a payment methodology established by the Sec-
retary.
‘‘(2) EFFECTIVE
DATE.—Paragraph (1) shall
apply to services furnished during cost reporting pe-
riods which begin after the date on which the Sec-
retary establishes the payment methodology and the
certification criteria described in paragraph (1).
‘‘(g) REPORT BY MEDICARE PROSPECTIVE PAYMENT
REVIEW COMMISSION.—During the first 3 years in which
payments are made under this section, the Medicare Pro-
spective Payment Review Commission shall annually sub-
mit a report to Congress on the effectiveness of the pay-
ment methodology established under this section that shall
include recommendations regarding the following:
‘‘(1) Case-mix and volume increases.
‘‘(2) Quality monitoring of home health agency
practices.
‘‘(3) Whether providers of service are ade-
quately reimbursed.
‘‘(4) On the adequacy of the exemptions and ex-
ceptions to the limits provided under subsection
(c)(1)(E).
‘‘(5) The appropriateness of the methods pro-
vided under this section to adjust the aggregate lim-
its and annual payment updates to reflect changes
in the mix of services, number of visits, and assign-
ment to case categories to reflect changing patterns
of home health care.
‘‘(6) The geographic areas used to determine
the per episode and per patient limits.
‘‘(h) DEVELOPMENT
OF EPISODIC PROSPECTIVE
PAYMENT SYSTEM FOR HOME HEALTH SERVICES.—
‘‘(1) IN GENERAL.—The Secretary shall develop
a method payments for home health services under
this title in accordance with an episodic prospective
payment system. In developing the system, the Sec-
retary shall take into consideration—
‘‘(A) the data and processes from sub-
section (c)(2) that have proven valid and reli-
able, and
‘‘(B) the degree of disruption resulting
from changing the payment system.
‘‘(2) ADDITIONAL CONSIDERATIONS.—The per
episode amount under the system shall include all
services covered and paid under home health services
under this title as of the date of the enactment of
this section, including medical supplies. In defining
an episode of care under the system, the Secretary
shall consider an appropriate length of time for an
episode, the use of services and the number of visits
provided within an episode, potential changes in the
mix of services provided within an episode and their
cost, and a general system design that will provide
for continued access to quality services. The per epi-
sode amount shall be based on the most current data
available to the Secretary and shall include consider-
ation of the cost of new regulatory requirements,
changes in technology, and new care practices.
‘‘(3) USE OF CASE MIX ADJUSTER.—Under the
system the Secretary shall employ an appropriate
case mix adjuster that explains a significant amount
of the variation in cost.
‘‘(4) UPDATES
AND
LABOR
ADJUSTMENT.—
Under the system, the episode payment amount shall
be updated annually by the home health market bas-
ket index and the labor portion of the episode
amount shall be adjusted for geographic differences
in labor-related costs based on the most current hos-
pital wage index.
‘‘(5) OUTLIERS.—Under the system the Sec-
retary may designate a payment provision for
outliers, recognizing the need to adjust payments
due to unusual variations in the type or amount of
medically necessary care.
‘‘(6) COORDINATION
REQUIREMENT.—Under
the system, a home health agency shall be respon-
sible for coordinating all care for a beneficiary under
this title.
‘‘(7) INPUT.—The system shall be developed
with input from and coordination with representa-
tives from the home health services industry and
consumers of home health services.
‘‘(8) PROPOSAL.—The Secretary shall submit to
Congress a proposal for the system, consistent with
this subsection, not later than 4 years after the date
of the enactment of this section.
‘‘(9) IMPLEMENTATION.—The system developed
under this subsection shall become effective only
pursuant to an Act of Congress. It is the intent of
Congress that the effective date of the system be not
later than 18 months after the enactment of such an
Act.
‘‘(i) DEVELOPMENT
OF DATA BASE.—Within 60
days after the date of the enactment of this section, the
Secretary shall initiate the development of a data base
upon which a fair and accurate case mix adjustor, as re-
quired by subsections (c)(2)(C) and (h)(3), can be devel-
oped and implemented. The data base must—
‘‘(1) be capable of linking case mix data with
cost and utilization data;
‘‘(2) contain data from HCFA Forms 485 and
UB–92;
‘‘(3) contain additional data elements sufficient
to support the case-mix categories in subsection
(c)(2)(C); and
‘‘(4) contain any additional data elements de-
termined necessary by the Secretary in consultation
with representatives of the home health industry.’’.
(b) APPEALS TO PROVIDER REIMBURSEMENT RE-
VIEW BOARD.—Section 1878(a) of such Act (42 U.S.C.
1395oo(a)) is amended by inserting ‘‘, any home health
agency which has received payment pursuant to section
1894 may obtain a hearing by the Board, with respect
to such payment,’’ after ‘‘subsection (h)’’.
(c) SUNSET OF REASONABLE COST LIMITATIONS.—
Section 
1861(v)(1)(L) 
of 
such 
Act 
(42 
U.S.C.
1395x(v)(1)(L)) is amended by adding at the end the fol-
lowing new clause:
‘‘(iv) This subparagraph shall apply only to services
furnished by home health agencies before the effective
date of section 1894.’’.
(d) EFFECTIVE DATE.—The amendments made by
subsections (a) and (c) shall apply to payment for home
health services furnished on or after such date (not later
than 6 months after the date of the enactment of this Act)
as the Secretary of Health and Human Services specifies.
SEC. 3. REVIEW BY PEER REVIEW ORGANIZATION OF HOME
HEALTH SERVICES.
(a) IN GENERAL.—Section 1154 of the Social Secu-
rity Act (42 U.S.C. 1320c–3) is amended following new
subsections:
‘‘(g)(1) Each contract under this part shall require
that the utilization and quality control peer review organi-
zation’s review responsibility pursuant to subsection (a)(1)
will include review of the level of care and quality of serv-
ices provided individuals receiving home health services
pursuant to sections 1812(a)(3) and 1832(a)(2)(A)(i).
‘‘(2) If—
‘‘(A) a home health agency has determined that
a patient does not meet the conditions for payment
of home health services under section 1814 or sec-
tion 1833,
‘‘(B) the home health agency has determined
that a patient no longer requires home health serv-
ices,
‘‘(C) the home health agency has determined
that a patient requires a level of care which is incon-
sistent with the care prescribed by the patient’s at-
tending physician, or
‘‘(D) the patient has been authorized by the
home health agency to receive a level of care less
than that considered by the patient as appropriate
to meet the patient’s needs,
the home health agency shall provide the patient (or the
patient’s representative) with a notice (meeting the condi-
tions prescribed by the Secretary under section 1879) of
the determination.
‘‘(3)(A) If the patient (or patient’s representative)—
‘‘(i) has received a notice under paragraph
(2), and
‘‘(ii) requests the appropriate peer review
organization to review the determination,
the organization shall conduct a review under sub-
section (a) of the validity of the home health agen-
cy’s determination and shall provide notice (by tele-
phone and in writing) to the patient or representa-
tive and the home health agency and attending phy-
sician involved of the results of the review. Such re-
view shall be conducted regardless of whether the
home health agency will charge for continued home
health services or whether the patient will be liable
for payment for such continued care.
‘‘(B) If a patient (or a patient’s representative) re-
quests review under subparagraph (A) while the patient
is still a patient of the home health agency and not later
than noon of the first working day after the date the pa-
tient receives the notice under paragraph (2), then—
‘‘(i) the home health agency shall provide to the
appropriate peer review organization the records re-
quired to review the determination by the close of
business of such first working day, and
‘‘(ii) the peer review organization must provide
the notice under subparagraph (A) by not later than
one full working day after the date the organization
has received the request and such records.
‘‘(4) If—
‘‘(A) a request is made under paragraph (3)(A)
not later than noon of the first working day after
the date that the patient (or patient’s representa-
tive) receives the notice under paragraph (2), and
‘‘(B) the conditions described in section
1879(a)(2) with respect to the patient or representa-
tive are met,
the home health agency shall not charge the patient for
home health services furnished before noon of the day
after the date the patient or representative receives notice
of the peer review organization’s decision.
‘‘(5) In any review conducted under paragraph (2)
or (3), the organization shall solicit the views of the pa-
tient involved (or the patient’s representative).
‘‘(h) The utilization and quality control peer review
organization shall monitor the delivery of home health
services in a manner which includes a review of home
health agencies that present significant variation in utili-
zation.’’.
(b) HEARING RIGHTS.—Section 1155 of such Act (42
U.S.C. 1320c–4) is amended by adding at the end the fol-
lowing: ‘‘Notwithstanding the previous provisions of this
section, any beneficiary receiving home health services
subject to review under section 1154(g), and the provider,
who is dissatisfied with a determination, shall be entitled
to a hearing by the Secretary and to judicial review of
any final determination to the same extent as provided
under section 1869.’’.
(c) 
ELIMINATION
OF
CERTAIN
FISCAL
INTERMEDIARY RESPONSIBILITIES.—Section 1816(j) of
such Act (42 U.S.C. 1395h(j)) is amended by striking
‘‘home health services,’’.
(d) EFFECTIVE DATE.—The amendments made by
subsections (a) and (c) shall apply to contract years begin-
ning after the date of the enactment of this Act.
SEC. 4. RETROACTIVE REINSTATEMENT OF PRESUMPTIVE
WAIVER OF LIABILITY.
(a) IN GENERAL.—Section 9305(g)(3) of the Omni-
bus Budget Reconciliation Act of 1986, as amended by
section 426(d) of the Medicare Catastrophic Coverage Act
of 1988 and section 4207(b)(3) of the Omnibus Budget
Reconciliation Act of 1990 (as renumbered by section
160(d)(4) of the Social Security Act Amendments of
1994), is amended by striking ‘‘December 31, 1995’’ and
inserting ‘‘the date of implementation of a prospective
payment system for home health care services under sec-
tion 1894(h) of the Social Security Act’’.
(b) PRESUMPTION.—The second sentence of section
9205 of the Consolidated Omnibus Budget Reconciliation
Act of 1985 is amended by striking ‘‘December 31, 1995’’
and inserting ‘‘the date of implementation of a prospective
payment system for home health care services under sec-
tion 1894(h) of such Act’’.
Æ