I 
115TH CONGRESS 
2D SESSION 
H. R. 6932 
To amend title XVIII of the Social Security Act to improve home health 
payment reforms under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 27, 2018 
Mr. ABRAHAM (for himself, Mr. DESJARLAIS, Mr. BUCHANAN, Ms. SEWELL 
of Alabama, and Mr. GRAVES of Louisiana) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined 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 improve 
home health payment reforms 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. IMPROVEMENTS TO HOME HEALTH PAYMENT 
REFORMS UNDER MEDICARE. 
(a) APPLICATION OF BUDGET NEUTRALITY.—Sec-
tion 1895(b)(3) of the Social Security Act (42 U.S.C. 
1395fff(b)(3)), as amended by section 51001(a)(2) of the 
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Bipartisan Budget Act of 2018 (Public Law 115–123), 
is amended— 
(1) in subparagraph (A)(iv), in the fourth sen-
tence— 
(A) by striking ‘‘shall make’’ and inserting 
‘‘shall not make’’; and 
(B) by striking ‘‘and shall provide a de-
scription’’ and all that follows through the pe-
riod and inserting a period; 
(2) in subparagraph (D)— 
(A) in the subparagraph heading, by strik-
ing ‘‘ASSUMPTIONS’’ and inserting ‘‘OBSERVED 
EVIDENCE’’; 
(B) in clause (i)— 
(i) by striking ‘‘differences between 
assumed’’ and all that follows through 
‘‘and actual’’; 
(ii) by inserting ‘‘attributable to the 
implementation of paragraphs (2)(B) and 
(4)(B)’’ after ‘‘behavior changes’’; and 
(iii) by adding at the end the fol-
lowing: ‘‘The Secretary shall publish the 
determination under this clause with re-
spect to an applicable year, including a de-
scription of the observed evidence used to 
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make such determination, in the notice and 
comment rulemaking to update the pro-
spective payment system under this sub-
section for such year. For purposes of the 
preceding sentence, the term ‘observed evi-
dence’ means statistically valid data from 
the most recent cost report and claims re-
garding changes in the nature of home 
health agency patients, patterns of care, 
service costs, and claims coding after Jan-
uary 1, 2020, reflecting behavioral changes 
relating to implementation of the provi-
sions of and amendments made by section 
51001 of the Bipartisan Budget Act of 
2018 (Public Law 115–123).’’; 
(C) in clause (ii), by inserting ‘‘attrib-
utable to the implementation of paragraphs 
(2)(B) and (4)(B)’’ after ‘‘expenditures’’; and 
(D) in clause (iii)— 
(i) by adding ‘‘attributable to the im-
plementation of paragraphs (2)(B) and 
(4)(B)’’ after ‘‘expenditures’’; and 
(ii) by adding at the end the fol-
lowing: ‘‘If such a temporary increase or 
decrease does not exceed 2.00 percent in 
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any given year, the Secretary shall apply 
the entire increase or decrease in the next 
calendar year payment update; however, if 
such a temporary increase or decrease ex-
ceeds 2.00, to provide for minimal disrup-
tion to patients and providers, the Sec-
retary shall phase in the temporary in-
crease or decrease in equal amounts not to 
exceed 2.00 percent in any given year 
through the respective calendar year pay-
ment updates.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of such section 51001(a)(2). 
Æ 
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