I
106TH CONGRESS
1ST SESSION
H. R. 2744
To amend title XVIII of the Social Security Act to modify the interim
payment system for home health services, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
AUGUST 5, 1999
Mrs. EMERSON introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Com-
merce, for a period to be subsequently determined by the Speaker, in
each case for consideration of such provisions as fall within the jurisdic-
tion of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to modify
the interim payment system for home health services,
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 ‘‘Home Health Equity
Act of 1999’’.
SEC. 2. ELIMINATION OF AUTOMATIC 15 PERCENT REDUC-
TION IN HOME HEALTH PAYMENTS.
(a) IN GENERAL.—
(1) CONTINGENCY REDUCTION.—Section 4603
of the Balanced Budget Act of 1997 (Public Law
105–33) (42 U.S.C. 1395fff note), as amended by
section 5101(c)(3) of the Tax and Trade Relief Ex-
tension Act of 1998 (contained in Division J of Pub-
lic Law 105–277), is amended by striking subsection
(e).
(2) PROSPECTIVE PAYMENT SYSTEM.—Section
1895(b)(3)(A) of the Social Security Act (42 U.S.C.
1395fff(b)(3)(A)) is amended—
(A) by striking ‘‘INITIAL BASIS.—’’ and all
that follows through ‘‘Under such system’’, and
inserting ‘‘INITIAL
BASIS.—Under such sys-
tem’’;
(B) in clause (i), by striking ‘‘but if the re-
duction in limits described in clause (ii) had
been in effect’’; and
(C) by striking clause (ii).
SEC. 3. OUTLIER PAYMENTS.
(a) WAIVER
OF PER BENEFICIARY LIMITS
FOR
OUTLIERS.—
(1) IN GENERAL.—Section 1861(v)(1)(L) of the
Social Security Act (42 U.S.C. 1395x(v)(1)(L)), as
amended by section 5101(a) of the Tax and Trade
Relief Extension Act of 1998 (contained in Division
J of Public Law 105–277) is amended—
(A) by redesignating clause (ix) as clause
(x); and
(B) by inserting after clause (viii) the fol-
lowing:
‘‘(ix)(I) Notwithstanding the applicable per bene-
ficiary limit under clause (v), (vi), or (viii), but subject
to the applicable per visit limit under clause (i), in the
case of a provider that demonstrates to the Secretary that
with respect to an individual to whom the provider fur-
nished home health services appropriate to the individual’s
condition (as determined by the Secretary) at a reasonable
cost (as determined by the Secretary), and that such rea-
sonable cost significantly exceeded such applicable per
beneficiary limit because of unusual variations in the type
or amount of medically necessary care required to treat
the individual, the Secretary, upon application by the pro-
vider, shall pay to such provider for such individual such
reasonable cost.
‘‘(II)(aa) The Secretary shall establish such criteria
as is required for payment under this clause, including a
description of the type of individual, condition, unusual
variations, and home health service that qualifies for such
payment.
‘‘(bb) In establishing criteria under item (aa), the
Secretary shall consider the information gathered in order
to establish case mix adjustment factors under section
1895(b)(4)(B) and any available Outcomes and Assess-
ment Information Set (OASIS) case mix data.
‘‘(III) In making determinations under subclause (I),
the Secretary shall use data from the cost report, or from
other data collected by the Secretary, of the provider for
such year.
‘‘(IV) A provider may make an application for pay-
ment under this clause for a fiscal year no earlier than
the end of the cost reporting period beginning in such fis-
cal year.
‘‘(V) The total amount of the additional payments
made to home health agencies pursuant to subclause (I)
in any fiscal year shall not be less than an amount equal
to 3 percent of the amounts that would have been paid
under this subparagraph in such year if this clause had
not been enacted and shall not exceed 4 percent of such
amounts.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect on the date of enactment
of this Act, and apply with respect to each application for
payment of reasonable costs for outliers submitted by any
home health agency for cost reporting periods ending on
or after September 30, 1999.
SEC. 4. RECOUPMENT OF OVERPAYMENTS.
(a) 36-MONTH REPAYMENT PERIOD.—
(1) IN GENERAL.—Except as provided in para-
graph (2), in the case of an overpayment by the Sec-
retary of Health and Human Services to a home
health agency for home health services furnished
during a cost reporting period beginning on or after
October 1, 1997, as a result of payment limitations
provided for under clause (v), (vi), or (viii) of section
1861(v)(1)(L) of the Social Security Act (42 U.S.C.
1395x(v)(1)(L)), the home health agency may elect
to repay the amount of such overpayment over a 36-
month period beginning on the date of notification
of such overpayment.
(2) EXCEPTION.—No home health agency may
make an election under paragraph (1) if any final
adverse action (as defined in section 1128E(g)(1))
has been taken against such agency.
(b) NO INTEREST ON OVERPAYMENT AMOUNTS.—In
the case of an agency that makes an election under sub-
section (a), no interest shall accrue on the outstanding
balance of the amount of overpayment during such 36-
month period.
(c) TERMINATION.—No election under subsection (a)
may be made for cost reporting periods, or portions of cost
reporting periods beginning on or after the date of the
implementation of the prospective payment system for
home health services under section 1895 of the Social Se-
curity Act (42 U.S.C. 1395fff).
(d) EFFECTIVE DATE.—The provisions of subsection
(a) shall take effect as if included in the enactment of the
Balanced Budget Act of 1997.
SEC. 5. INCREASE IN PAYMENT AMOUNT TO AGENCIES
WITH LIMITS UNDER THE NATIONAL AVER-
AGE.
(a) IN GENERAL.—Section 1861(v)(1)(L)(viii)(I) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395x(v)(1)(L)(viii)(I)), as added by section 5101(a)(3) of
the Tax and Trade Relief Extension Act of 1998 (con-
tained in Division J of Public Law 105–277), is amended
by striking ‘‘the limit otherwise imposed under clause (v)’’
and all that follows through the period and inserting ‘‘the
limit for such provider and period shall be an amount
equal to—
‘‘(aa) for cost reporting periods beginning dur-
ing fiscal year 1999, 90 percent of such median;
‘‘(bb) for cost reporting periods beginning dur-
ing fiscal year 2000, 95 percent of such median; and
‘‘(cc) for cost reporting periods beginning dur-
ing or after fiscal year 2001, such median.’’.
(b) EFFECTIVE DATE.—The provisions of subsection
(a) shall take effect as if included in the enactment of the
Tax and Trade Relief Extension Act of 1998 (contained
in Division J of Public Law 105–277).
SEC. 6. INCREASE IN PER VISIT LIMIT.
Section 1861(v)(1)(L)(i) of the Social Security Act
(42 U.S.C. 1395x(v)(1)(L)(i)), as amended by section
5101(a) of the Tax and Trade Relief Extension Act of
1998 (contained in Division J of Public Law 105–277),
is amended—
(1) in subclause (IV), by striking ‘‘or’’;
(2) in subclause (V)—
(A) by inserting ‘‘and before October 1,
1999,’’ after ‘‘October 1, 1998,’’; and
(B) by striking the period and inserting ‘‘,
or’’; and
(3) by adding at the end the following:
‘‘(VI) October 1, 1999, 108 percent of such me-
dian.’’.
SEC. 7. ELIMINATION OF TIMEKEEPING REQUIREMENTS
UNDER THE PROSPECTIVE PAYMENT SYSTEM
FOR HOME HEALTH AGENCIES.
(a) IN GENERAL.—Section 1895(c) of the Social Se-
curity Act (42 U.S.C. 1395fff(c)) is amended—
(1) by striking ‘‘unless—’’ and all that follows
through ‘‘(1) the’’ and inserting ‘‘unless the’’; and
(2) by striking ‘‘1835(a)(2)(A);’’ and all that
follows 
through 
the 
period 
and 
inserting
‘‘1835(a)(2)(A).’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall take effect on the date of enactment
of this Act.
SEC. 8. PERIODIC INTERIM PAYMENT FOR CERTAIN HOME
HEALTH AGENCIES.
(a) IN GENERAL.—Section 1815(e)(2)(D) of the So-
cial Security Act (42 U.S.C. 1395g(e)(2)(D)) is amended
by inserting ‘‘until the end of the 12-month period fol-
lowing the date that the prospective payment system for
such services is implemented pursuant to section 1895’’
after ‘‘services’’.
(b) CONFORMING AMENDMENT.—Section 4603(b) of
the Balanced Budget Act of 1997 (Public Law 105–33)
is repealed.
(c) EFFECTIVE DATE.—The amendment made by
this section shall take effect as if included in the enact-
ment of the Balanced Budget Act of 1997 (Public Law
105–33).
SEC. 9. REVISION OF SURETY BOND REQUIREMENT FOR
HOME HEALTH AGENCIES.
(a) IN GENERAL.—Section 1861(o) of the Social Se-
curity Act (42 U.S.C. 1395x(o)) is amended by inserting
after the first sentence the following: ‘‘The surety bond
required under paragraph (7) shall be used by the Sec-
retary to protect against overpayments made to an agency
based on fraudulent claims or behavior but shall not be
used to protect against overpayments that are not based
on such claims or behavior.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect on the date of enactment
of this Act.
SEC. 10. EXCLUSION OF ADDITIONAL PART B COSTS FROM
DETERMINATION OF PART B MONTHLY PRE-
MIUM.
Section 1839(g) of the Social Security Act (42 U.S.C.
1395r(g)) (as added by section 5101(e) of the Tax and
Trade Relief Extension Act of 1998 (contained in division
J of Public Law 105–277)) is amended by striking ‘‘sec-
tion 1861(v)(1)(L)(viii) or to the establishment under sec-
tion 1861(v)(1)(L)(i)(V) of a per visit limit at 106 percent
of the median (instead of 105 percent of the median)’’
and inserting ‘‘clauses (viii) and (ix) of section
1861(v)(1)(L) or to the establishment under section
1861(v)(1)(L)(i)(V) of a per visit limit at 106 percent and
108 percent of the median (instead of 105 percent of the
median and 106 percent of the median, respectively)’’.
Æ