Title: Home Health Payment Innovation Act of 2019
Policy area: Health

Summary:
Home Health Payment Innovation Act of 2019
This bill makes a series of changes relating to payment and coverage of home health services under Medicare and Medicare Advantage (MA).
Specifically, the bill allows the home-confinement requirement (also known as the homebound requirement) for home health services to be waived under Medicare and MA. Currently, as a condition of eligibility for such services, a physician must certify that an individual has difficulty leaving home without assistance (e.g., a wheelchair, special transportation, or help from another person) due to an illness or injury.
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 116th Congress]
[From the U.S. Government Publishing Office]
[S. 433 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                 S. 433

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

                           February 11, 2019

  Ms. Collins (for herself, Ms. Stabenow, Mr. Kennedy, Mr. Jones, Mr. 
  Cassidy, Mr. Paul, and Mrs. Shaheen) 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 2019''.

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:
    ``(o) 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 ``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 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 `evidence' means 
                        the most recent data after January 1, 2020, 
                        that reflects the difference between real 
                        changes in case mix and 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. In the case where such a temporary 
                        increase or decrease exceeds 2.00, 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 necessary to achieve budget 
                        neutrality by 2029. Prior to implementing such 
                        phase-in adjustments after 2025, the Secretary 
                        shall first receive certification from the 
                        Office 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 enactment of such section 51001(a)(2).
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