I 
116TH CONGRESS 
1ST SESSION H. R. 2573 
To amend title XVIII of the Social Security Act to improve home health 
payment reforms under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 8, 2019 
Ms. SEWELL of Alabama (for herself, Mr. BUCHANAN, Mr. ABRAHAM, Ms. 
KUSTER of New Hampshire, Mr. LARSON of Connecticut, Mr. MARCH-
ANT, Mr. GRAVES of Louisiana, Mr. ARRINGTON, Mr. THORNBERRY, Mr. 
PANETTA, and Mr. DESJARLAIS) introduced the following bill; which was 
referred to the Committee on Ways and Means, and in addition to the 
Committee on Energy and Commerce, for a period to be subsequently de-
termined 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. SHORT TITLE. 
This Act may be cited as the ‘‘Home Health Payment 
Innovation Act of 2019’’. 
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SEC. 2. IMPROVEMENTS TO MEDICARE INNOVATIONS AND 
MANAGED CARE RELATED TO HOME HEALTH 
SERVICES. 
(a) EXPANDED WAIVERS IN SHARED SAVINGS PRO-
GRAMS.—Section 1899(f) of the Social Security Act (42 
U.S.C. 395jjj(f)), is amended by adding at the end the 
following: ‘‘Beginning not later than January 1, 2020, the 
Secretary shall include a waiver of the ‘confined to his 
home’ requirement under sections 1814(a)(2)(C) and 
1835(a)(2)(A) in one or more programs under this sec-
tion.’’. 
(b) 
FLEXIBILITY
IN
MEDICARE
ADVANTAGE 
PLANS.—Section 1852 of the Social Security Act (42 
U.S.C. 1395ww–2) is amended by adding at the end the 
following: 
‘‘(o) FLEXIBILITY
IF PROVIDING HOME HEALTH 
SERVICES.—Notwithstanding any other provision of law, 
any MA organization shall be permitted to waive the ‘con-
fined to his home’ requirement in the home health services 
benefit when the organization determines it is in the best 
interest of the enrollee.’’. 
SEC. 3. IMPROVEMENTS TO HOME HEALTH PAYMENT RE-
FORMS 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; and 
(2) in subparagraph (D)— 
(A) in the subparagraph heading, by strik-
ing ‘‘ASSUMPTIONS’’ and inserting ‘‘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 evidence used to make such 
determination, in the notice and comment 
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rulemaking to update the prospective pay-
ment system under this subsection for such 
year. For purposes of the preceding sen-
tence, the term ‘evidence’ means the most 
recent data after January 1, 2020, that re-
flects the difference between real changes 
in case mix and behavioral changes relat-
ing to implementation of the provisions 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 
any given year, the Secretary shall apply 
the entire increase or decrease in the next 
calendar year payment update. In the case 
where such a temporary increase or de-
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crease exceeds 2.00 percent, the Secretary 
shall phase in the temporary increase or 
decrease in equal amounts not to exceed 
2.00 percent in any given year through the 
respective calendar year payment updates. 
Notwithstanding the preceding sentence, 
the Secretary shall complete any such 
phase-in adjustment no later than 2029 
and shall have the authority, after 2025, to 
waive the phase-in requirement as nec-
essary to achieve budget neutrality by 
2029. Prior to implementing such phase-in 
adjustments after 2025, the Secretary 
shall first receive certification from the Of-
fice of the Actuary of the Centers for 
Medicare & Medicaid Services that any 
such adjustments are appropriate.’’. 
(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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