Title: Rural Home Health Extension and Regulatory Relief Act
Policy area: Health

Summary:
Rural Home Health Extension and Regulatory Relief Act
This bill (1) makes transitional adjustments to the home-health groupings model for payment under Medicare's prospective-payment system, and (2) extends a payment increase for Medicare home-health services furnished to patients in rural areas.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3992 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 3992

 To amend title XVIII of the Social Security Act to delay application 
  of, transition to, and limit savings for the home health groupings 
 model under the Medicare home health prospective payment system, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 6, 2017

  Mrs. Noem 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 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 delay application 
  of, transition to, and limit savings for the home health groupings 
 model under the Medicare home health prospective payment system, and 
                          for other purposes.

    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 ``Rural Home Health Extension and 
Regulatory Relief Act''.

SEC. 2. DELAYING APPLICATION OF, TRANSITIONING TO, AND LIMITING SAVINGS 
              FOR HOME HEALTH GROUPINGS MODEL UNDER MEDICARE HOME 
              HEALTH PROSPECTIVE PAYMENT SYSTEM; HOME HEALTH RURAL ADD-
              ON.

    (a) Delayed Implementation of Home Health Groupings Model With 
Limit on Savings and With Transition.--
            (1) In general.--Section 1895(b) of the Social Security Act 
        (42 U.S.C. 1395fff(b)) is amended by inserting at the end the 
        following new paragraph:
            ``(7) Implementation of home health groupings model.--
                    ``(A) Use of home health groupings model with 
                delayed implementation.--For purposes of calculating 
                standard prospective payment amounts under the 
                prospective payment system under this subsection with 
                respect to home health units of service furnished on or 
                after January 1, 2020, and subject to the succeeding 
                subparagraphs of this paragraph, the Secretary shall 
                apply the home health groupings model including use of 
                a 30-day unit of payment, as described in the proposed 
                rule entitled `Medicare and Medicaid Programs; CY 2018 
                Home Health Prospective Payment System Rate Update and 
                Proposed CY 2019 Case-Mix Adjustment Methodology 
                Refinements; Home Health Value-Based Purchasing Model; 
                and Home Health Quality Reporting Requirements' (82 
                Fed. Reg. 35294 through 35332 (July 28, 2017) (herein 
                referred to as `the 2018 Home Health Proposed Rule')) 
                and as such model may subsequently be revised through 
                notice and comment rulemaking.
                    ``(B) Calculation of budget neutral payment 
                amounts.--
                            ``(i) In general.--The Secretary shall, 
                        subject to subparagraph (F), calculate payment 
                        amounts under this subsection with respect to 
                        home health 30-day periods of care furnished in 
                        2020 in a manner such that the estimated 
                        aggregate amount of expenditures under the 
                        prospective payment system under this 
                        subsection with application of this paragraph 
                        is equal to the estimated aggregate amount of 
                        expenditures under this subsection without 
                        application of this paragraph.
                            ``(ii) Exclusion of adjustments from 
                        calculation.--Adjustments under paragraph (3) 
                        (including adjustments for case mix changes 
                        under clause (iv) of such paragraph) and 
                        paragraph (5) and subparagraphs (E) and (F) 
                        shall not be included in the calculation under 
                        clause (i).
                    ``(C) Limiting savings compared to the 2018 home 
                health proposed rule.--In order to reduce the aggregate 
                amount of savings under the home health groupings model 
                compared to the estimated impacts in the 2018 Home 
                Health Proposed Rule, after calculating amounts in 
                subparagraph (B), the Secretary shall reduce such 2020 
                amounts by 3.7 percent.
                    ``(D) Standard prospective payment amounts for 2020 
                and subsequent years.--
                            ``(i) Standard prospective payment 
                        amounts.--The standard prospective payment 
                        amounts for home health 30-day periods of care 
                        beginning with 2020 shall be the amounts 
                        reduced in subparagraph (C) subject to clauses 
                        (iv) and (v) of subparagraph (F).
                            ``(ii) Application of adjustments.--
                        Adjustments described in subparagraph (B)(ii) 
                        (other than the adjustment described in 
                        subparagraph (E)) shall be applied to such 
                        standard prospective payment amounts.
                    ``(E) Transitional adjustments to home health 
                groupings model.--In order to provide for a transition 
                to the home health groupings model, the Secretary 
                shall, after application of adjustments described in 
                subparagraph (D)(ii), increase payment amounts under 
                clause (iii) as follows:
                            ``(i) For 2020, the increase shall be 1.5 
                        percent.
                            ``(ii) For 2021, the increase shall be 1.0 
                        percent.
                            ``(iii) For 2022, the increase shall be 0.5 
                        percent.
                    ``(F) Provider behavior assumptions and 
                reconciliation.--
                            ``(i) Assumptions.--In calculating amounts 
                        under subparagraph (B)(i), the Secretary shall 
                        make assumptions about provider behavioral 
                        change that could occur as a result of 
                        implementation of the home health groupings 
                        model such as for changes in the number of 
                        service units and changes in diagnosis codes 
                        billed.
                            ``(ii) Description of assumptions.--The 
                        Secretary shall provide a description of the 
                        assumptions made under clause (i) in the notice 
                        and comment rulemaking used to implement this 
                        paragraph.
                            ``(iii) Reconciliation.--Not later than 
                        2025, and in subsequent years as appropriate, 
                        the Secretary shall determine the impact of 
                        differences between actual and assumed behavior 
                        on estimated aggregate expenditures under this 
                        subsection.
                            ``(iv) Permanent adjustments.--The 
                        Secretary shall, at a time and in a manner 
                        determined appropriate, provide for one or more 
                        permanent increases or decreases to the 
                        standard prospective payment amounts for 
                        applicable years, on a prospective basis, to 
                        account for the determination under clause 
                        (iii).
                            ``(v) Temporary adjustments for 
                        retrospective behavior.--The Secretary shall, 
                        at a time and in a manner determined 
                        appropriate, provide for one or more temporary 
                        increases or decreases to the standard 
                        prospective payment amounts for applicable 
                        years, on a prospective basis, to account for 
                        the determination under clause (iii) with 
                        respect to years before the adjustment in 
                        clause (iv).
                            ``(vi) Other behavior.--The Secretary 
                        shall, at a time and in a manner determined 
                        appropriate, apply permanent and temporary 
                        adjustments to adjust for increases in 
                        estimated aggregate expenditures as a result of 
                        behavior responses not described in clause 
                        (ii).
                    ``(G) Continued application of provisions.--Except 
                as described in this paragraph, the provisions of this 
                section shall continue to apply.''.
            (2) Conforming amendment.--Paragraph (2) of section 1895(b) 
        of the Social Security Act (42 U.S.C. 1395fff(b)(2)) is amended 
        by striking ``In'' and inserting ``Subject to paragraph (7)(A), 
        in''.
    (b) Extension of Home Health Rural Add-On.--Section 421 of the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
(Public Law 108-173; 117 Stat. 2283), as amended by section 5201(b) of 
the Deficit Reduction Act of 2005 (Public Law 109-171; 120 Stat. 46), 
section 3131(c) of the Patient Protection and Affordable Care Act 
(Public Law 111-148; 124 Stat. 428), and section 210 of the Medicare 
Access and CHIP Reauthorization Act of 2015 (Public Law 114-10; 129 
Stat. 87), is amended by striking ``January 1, 2018'' each place it 
appears and inserting ``January 1, 2023''.
    (c) Reports.--
            (1) Interim report.--Not later than March 15, 2022, the 
        Medicare Payment Advisory Commission shall submit to Congress 
        an interim report on the modifications made by section 
        1895(b)(7) of the Social Security Act (42 U.S.C. 
        1395fff(b)(7)), as added by subsection (a), and any unintended 
        consequences including--
                    (A) behavioral changes that may occur due to lower 
                reimbursement for Medication Management, Training and 
                Assessment;
                    (B) behavioral changes that may occur due to higher 
                reimbursement following hospitalizations;
                    (C) use of statistically derived, versus actual, 
                payment weights;
                    (D) questionable encounters;
                    (E) use of both primary and secondary diagnosis 
                codes for episode assignment; and
                    (F) reducing reimbursement of behavioral health 
                episodes, compared to the Home Health Resource Group 
                model.
            (2) Final report.--Not later than March 15, 2026, MedPAC, 
        the Medicare Payment Advisory Commission shall submit to 
        Congress a final report on such modifications and any such 
        consequences.
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