I 
112TH CONGRESS 
2D SESSION 
H. R. 6059 
To amend title XVIII of the Social Security Act to protect Medicare 
beneficiaries’ access to home health services under the Medicare Program. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 29, 2012 
Mr. MCGOVERN (for himself and Mr. JONES) 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 protect 
Medicare beneficiaries’ access to home 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 ‘‘Home Health Care 
Access Protection Act of 2012’’. 
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SEC. 2. PROTECTING ACCESS TO MEDICARE HOME HEALTH 
SERVICES. 
Section 1895(b)(3)(B) of the Social Security Act (42 
U.S.C. 1395fff(b)(3)(B)) is amended— 
(1) in clause (iv), by striking ‘‘Insofar as’’ and 
inserting ‘‘Subject to clause (vii), insofar as’’; and 
(2) by adding at the end the following new 
clause: 
‘‘(vii) SPECIAL RULES FOR CASE MIX 
CHANGES FOR 2013 AND LATER.— 
‘‘(I) IN GENERAL.—The adjust-
ment under clause (iv) shall only be 
made for years beginning with 2013 
using standards developed by the Sec-
retary consistent with the processes 
described in subclause (II) taking into 
account the criteria described in sub-
clause (III). 
‘‘(II) PROCESSES AND CRITERIA 
FOR EVALUATING CHANGES IN CASE 
MIX.—For purposes of subclause (I), 
the processes described in this sub-
clause are the following: 
‘‘(aa) In developing stand-
ards referred to in such sub-
clause, the Secretary shall con-
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vene a Technical Advisory Group 
consisting of stakeholders, includ-
ing individuals and organizations 
representing 
the 
interests 
of 
Medicare beneficiaries, the home 
health community, health care 
academia, and health care profes-
sionals, in equal numbers from 
each and limited to parties with-
out an existing contractual rela-
tionship with the Secretary, to 
advise the Secretary concerning 
the establishment of such stand-
ards in order to distinguish be-
tween real changes in case mix 
and changes in coding or classi-
fication of different units of serv-
ices that do not reflect real 
changes in case mix. The Tech-
nical Advisory Group shall be 
given the opportunity to review 
and comment on any proposed 
rulemaking or final determina-
tion by the Secretary on such 
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standards prior to such rule-
making or determination. 
‘‘(bb) If the Secretary en-
gages an outside contractor to 
participate in the evaluation of 
case mix changes described in 
item (aa), the Secretary shall 
only utilize a contractor that has 
not previously participated in the 
design and establishment of the 
case 
mix 
adjustment 
factors 
under this subparagraph. 
‘‘(cc) If the Secretary deter-
mines that any increase in case 
mix relates to changes in the vol-
ume or nature of services pro-
vided to home health services pa-
tients, the Secretary shall evalu-
ate such increase through actual 
review of claims and services and 
shall not use any proxy or surro-
gate for determining whether the 
change in volume or nature of 
services is reasonable and nec-
essary. 
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‘‘(dd) The Secretary shall 
establish the standards referred 
to in item (aa) by regulation. 
‘‘(ee) With respect to estab-
lishment of such standards, the 
Secretary shall make public all 
data, reports, and supporting 
materials, including any com-
ments by the Technical Advisory 
Group pursuant to item (aa), re-
garding the standards at the time 
of notice of such standards. 
‘‘(III) CRITERIA.—The criteria 
described in this subclause are the fol-
lowing: 
‘‘(aa) The impact of changes 
in the program under this title 
that may affect the characteris-
tics of individuals receiving home 
health services. 
‘‘(bb) The impact of changes 
in the provision of health care 
services by providers of services 
other than home health agencies. 
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‘‘(cc) Distinctions in the 
characteristics of individuals ini-
tiating home health services from 
the community and institutional 
care settings. 
‘‘(dd) Whether any changes 
in coding resulted in a change in 
expenditures overall annually and 
disregarding changes in coding 
that do not have an overall ex-
penditure impact. 
‘‘(ee) Any other factors de-
termined appropriate by the Sec-
retary in consultation with the 
Technical Advisory Group under 
subclause (II)(aa).’’. 
Æ 
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