Title: Home Health Payment Innovation Act of 2018
Policy area: Health

Summary:
Home Health Payment Innovation Act of 2018
This bill allows the home confinement requirement for home health services to be waived under Medicare and Medicare Advantage. The bill also alters the payment methodology under the Medicare prospective payment system for home health services, including by eliminating the requirement that such methodology include certain behavioral assumptions regarding the implementation of specified changes to units of payment and case-mix adjustment factors.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3545 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 3545

To amend title XVIII of the Social Security Act to improve home health 
              payment reforms under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

            October 3 (legislative day, September 28), 2018

Ms. Collins (for herself, Ms. Stabenow, and Mr. Nelson) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 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 Representatives 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 2018''.

SEC. 2. IMPROVEMENTS TO MEDICARE INNOVATIONS AND MANAGED CARE RELATED 
              TO HOME HEALTH SERVICES.

    (a) Expanded Waivers in Shared Savings Programs.--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 section.''.
    (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:
    ``(n) Flexibility if Providing Home Health Services.--
Notwithstanding any other provision of law, any MA organization shall 
be permitted to waive the `confined 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 REFORMS UNDER MEDICARE.

    (a) Application of Budget Neutrality.--Section 1895(b)(3) of the 
Social Security Act (42 U.S.C. 1395fff(b)(3)), as amended by section 
51001(a)(2) of the Bipartisan Budget Act of 2018 (Public Law 115-123), 
is amended--
            (1) in subparagraph (A)(iv), in the fourth sentence--
                    (A) by striking ``shall make'' and inserting 
                ``shall not make''; and
                    (B) by striking ``and shall provide a description'' 
                and all that follows through the period and inserting a 
                period; and
            (2) in subparagraph (D)--
                    (A) in the subparagraph heading, by striking 
                ``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 following: 
                        ``The Secretary shall publish the determination 
                        under this clause with respect to an applicable 
                        year, including a description of the observed 
                        evidence used to make such determination, in 
                        the notice and comment rulemaking to update the 
                        prospective payment system under this 
                        subsection for such year. For purposes of the 
                        preceding sentence, the term `observed 
                        evidence' means statistically valid data from 
                        the most recent cost report and claims 
                        regarding changes in the nature of home health 
                        agency patients, patterns of care, service 
                        costs, and claims coding after January 1, 2020, 
                        reflecting behavioral changes relating 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 ``attributable to 
                the implementation of paragraphs (2)(B) and (4)(B)'' 
                after ``expenditures''; and
                    (D) in clause (iii)--
                            (i) by adding ``attributable to the 
                        implementation of paragraphs (2)(B) and 
                        (4)(B)'' after ``expenditures''; and
                            (ii) by adding at the end the following: 
                        ``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; however, if such a temporary increase 
                        or decrease exceeds 2.00, to provide for 
                        minimal disruption to patients and providers, 
                        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.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of such section 51001(a)(2).
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