I
106TH CONGRESS
2D SESSION
H. R. 4727
To amend title XVIII of the Social Security Act with respect to payments
made under the prospective payment system for home health services
furnished under the Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
JUNE 22, 2000
Mr. MCGOVERN (for himself, Mr. HILLEARY, Mr. WEYGAND, and Mr. PETER-
SON of Pennsylvania) 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 with respect
to payments made under the prospective payment system
for home health services furnished 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 ‘‘Equal Access to Medi-
care Home Health Care Act of 2000’’.
(6) The recent projections by the Congressional
Budget Office represent more than 4 times the
amount of the reduction in the medicare home
health benefit originally projected to take effect as
a result of the amendments made by the Balanced
Budget Act of 1997.
(7) The failure of the Health Care Financing
Administration to disburse payments under the in-
terim payment system established by the Balanced
Budget Act of 1997 under section 1861(v)(1)(L) of
the Social Security Act in a timely manner has re-
sulted in medicare overpayments to thousands of
providers of home health services, leaving many of
these providers on precarious financial footing.
(8) Access to care, particularly for high-cost
and long-term patients, has become a growing prob-
lem because the amount of payment for these types
of patients under the current interim payment sys-
tem is insufficient.
(9) Under the proposed regulation imple-
menting the new prospective payment system, 50
percent of the prospective payment amount will be
paid upon receipt and processing of the providers
initial claim for reimbursement and 50 percent of
that amount will be delayed until the final claim is
processed at the end of the 60-day episode period.
(10) Medicare beneficiaries incur most home
health care expenses during the first 30 days of a
60-day episode period and providers of home health
services do not have large cash reserves to support
delayed payment for those services under the medi-
care program.
(11) It is essential that the Administrator of
the Health Care Financing Administration ensure
that the initial payment to providers of home health
services during a 60-day episode period of home
health care provided under the medicare home
health benefit provides a steady cash flow for those
providers so that medicare beneficiaries may con-
tinue to receive necessary home health services.
(12) Studies by the Medicare Payment Advisory
Commission established under section 1805 of the
Social Security Act have indicated that certain popu-
lations of medicare beneficiaries risk not receiving
necessary home health services because of the sys-
temic changes made by the Balanced Budget Act of
1997.
(13) Because the aggregate amount of payment
made for all home health services during the first
year in which payment will be made for those serv-
ices under the prospective payment system is limited
to the amount that would have been paid in such
year for those services under the interim payment
system, there is an enormous risk that this limited
amount will be insufficient, resulting in a perpetua-
tion of the current crisis under the interim payment
system for home health services.
SEC. 3. ELIMINATION OF 15 PERCENT REDUCTION IN PAY-
MENT RATES UNDER THE MEDICARE PRO-
SPECTIVE 
PAYMENT 
SYSTEM 
FOR 
HOME
HEALTH SERVICES.
(a) IN GENERAL.—Section 1895(b)(3)(A) of the So-
cial Security Act (42 U.S.C. 1395fff(b)(3)(A)), as amend-
ed by sections 302(b) and 303(f) of the Medicare, Med-
icaid, and SCHIP Balanced Budget Refinement Act of
1999 (113 Stat. 1501A–359, 361), as enacted into law
by section 1000(a)(6) of Public Law 106–113, is amended
to read as follows:
‘‘(A) INITIAL BASIS.—Under such system
the Secretary shall provide for computation of
a standard prospective payment amount (or
amounts). Such amount (or amounts) shall ini-
tially be based on the most current audited cost
report data available to the Secretary and shall
be computed in a manner so that the total
amounts payable under the system for the 12-
month period beginning on the date the Sec-
retary implements the system shall be equal to
the total amount that would have been made
if the system had not been in effect and if sec-
tion 1861(v)(1)(L)(ix) had not been enacted.
Each such amount shall be standardized in a
manner that eliminates the effect of variations
in relative case mix and area wage adjustments
among different home health agencies in a
budget neutral manner consistent with the case
mix and wage level adjustments provided under
paragraph (4)(A). Under the system, the Sec-
retary may recognize regional differences or dif-
ferences based upon whether or not the services
or agency are in an urbanized area.’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall take effect as if included in the enact-
ment of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999 (Public Law 106–113).
SEC. 4. OVERPAYMENTS.
(a) 36-MONTH REPAYMENT PERIOD.—In the case of
an overpayment by the Secretary 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)), with respect to the repayment by the
home health agency of such overpayment, interest shall
accrue on the outstanding balance of that overpayment as
provided in subsection (b).
(b) INTEREST ON OVERPAYMENT AMOUNTS.—
(1) 36-MONTH
GRACE
PERIOD.—No interest
shall accrue on the outstanding balance of the
amount of overpayment during the 36-month period
beginning on the date of notification of the overpay-
ment.
(2) OVERDUE BALANCES.—Interest shall accrue
on any outstanding balance of the amount of over-
payment after the termination of such 36-month pe-
riod. Interest shall accrue under this paragraph at
the rate of interest charged by banks for loans to
their most favored commercial customers, as pub-
lished in the Wall Street Journal on the Friday im-
mediately following the date of the enactment of this
Act.
(c) TERMINATION.—The provisions of this section
shall not apply to an overpayment made by the Secretary
of Health and Human Services to a home health agency
for cost reporting periods, or portions of cost reporting
periods, beginning on or after the date of the implementa-
tion of the prospective payment system for home health
services under section 1895 of the Social Security 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. ADDITIONAL PAYMENTS UNDER THE PROSPECTIVE
PAYMENT 
SYSTEM 
FOR 
SERVICES 
FUR-
NISHED IN RURAL AREAS AND SECURITY
SERVICES.
(a) INCREASE
IN PAYMENT RATES
FOR RURAL
AGENCIES.—Section 1895(b) of the Social Security Act
(42 U.S.C. 1395fff(b)) is amended by adding at the end
the following new paragraph:
‘‘(7) ADDITIONAL
PAYMENT
AMOUNT
FOR
SERVICES
FURNISHED
IN
RURAL
AREAS.—In the
case of home health services furnished in a rural
area (as defined in section 1886(d)(2)(D)), the Sec-
retary shall provide for an addition or adjustment to
the payment amount otherwise made under this sec-
tion for services furnished in a rural area in an
riod to offset the increase in payments resulting
from the application of paragraph (7) (relating
to services furnished in rural areas) and para-
graph (8) (relating to costs of security serv-
ices).’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall take effect on the date that is 270 days
after the date of the enactment of this Act.
SEC. 
6. 
RULE 
OF 
CONSTRUCTION 
RELATING 
TO
TELEHOMEHEALTH SERVICES.
(a) IN GENERAL.—Section 1895(b) of such Act (42
U.S.C. 1395fff(b)(3)), as amended by section 3, is further
amended by adding at the end the following paragraph:
‘‘(9) RULE
OF
CONSTRUCTION
RELATING
TO
TELEHOMEHEALTH SERVICES.—
‘‘(A) IN GENERAL.—Nothing in this sec-
tion, or in section 4206(a) of the Balanced
Budget Act of 1997 (42 U.S.C. 1395l note),
shall be construed as preventing a home health
agency receiving payment under this section
from furnishing a home health service via a
telecommunications system.
‘‘(B) LIMITATION.—The Secretary shall
not consider a home health service provided in
the manner described in subparagraph (A) to
be a home health visit for purposes of—
‘‘(i) determining the amount of pay-
ment to be made under this section; or
‘‘(ii) any requirement relating to the
certification of a physician required under
section 1814(a)(2)(C).’’.
(b) REPORT.—Not later than one year after the date
of the enactment of this Act, the Secretary of Health and
Human Services shall submit to Congress a report con-
taining the recommendations of the Secretary with respect
to the feasibility and advisability of including home health
services furnished by telecommunications systems as a
home health service for purposes of—
(1) payment for such services under section
1895 of the Social Security Act (42 U.S.C. 1395fff),
and
(2) requirements with respect to physician cer-
tification of the need for home health services under
section 1814(a)(2)(C) of such Act (42 U.S.C.
1395f(a)(2)(C)).
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