I 113th CONGRESS 2d Session H. R. 5110 IN THE HOUSE OF REPRESENTATIVES July 15, 2014 Mr. Walden (for himself, Mr. Price of Georgia , Mrs. Ellmers , Mr. McKinley , Mr. Latham , Mr. Duffy , Mrs. McMorris Rodgers , Mr. Graves of Missouri , Mr. Boustany , Mr. Paulsen , Mr. Thompson of Pennsylvania , Mr. Young of Alaska , and Mr. Gardner ) 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 repeal rebasing of payments for home health services, as required under the Patient Protection and Affordable Care Act, and to replace such rebasing with a Medicare home health value-based purchasing program, and for other purposes.

1. Short title This Act may be cited as the Securing Access Via Excellence for Medicare Home Health Act of 2014 or the SAVE Medicare Home Health Act of 2014 . 2. Repeal of Medicare home health rebasing reduction provided under PPACA and detailed analysis of such reduction (a) Repeal of rebasing reduction and codification of CY 2014 payment adjustment (1) Repeal Section 1895(b)(3)(A) of the Social Security Act ( 42 U.S.C. 1395fff(b)(3)(A) ) is amended by striking clause (iii). (2) Codification Such section, as amended by paragraph (1), is further amended by adding at the end the following new clause: (iii) Codification of CY 2014 payment adjustment The amount (or amounts) that would otherwise be applicable under clause (i)(III) for 2015 and subsequent years shall be determined taking into account the 3.5 percentage point reduction effective for 2014 pursuant to the rule for home health prospective payment system rate update for calendar year 2014 (promulgated on December 2, 2013, 78 Federal Register 72256). . (b) Detailed analysis of rebasing reduction (1) In general The Secretary of Health and Human Services shall conduct a detailed analysis of the rebasing reduction in Medicare payments for home health services promulgated under the rule for home health prospective payment system rate update for calendar year 2014 (promulgated on December 2, 2013, 78 Federal Register 72256), pursuant to the Regulatory Flexibility Act, Executive Order 13563, section 3131(a) of the Patient Protection and Affordable Care Act, and other specified factors. Such analysis shall include an assessment of at least the following factors: (A) The age, poverty level, gender, rural residence, ethnic or racial minority, and infirmity of Medicare beneficiaries receiving home health services in comparison to other Medicare beneficiaries. (B) The number, gender, and geographic distribution of professional Medicare home health caregivers. (C) The number and location of home health agencies that have closed, consolidated, or been acquired since the rebasing reduction was implemented. (D) The number and location of professional home health caregiver jobs that have been lost since the rebasing reduction was implemented. (2) Report Not later than February 1, 2015, the Secretary shall submit to Congress a report that contains findings regarding the analysis conducted under paragraph (1), including the Secretary’s assessment of the factors specified in such paragraph. 3. Establishment of home health value-based purchasing (VBP) program (a) Readmission measures Section 1895 of the Social Security Act ( 42 U.S.C. 1395fff ) is amended by adding at the end the following new subsection: (f) Post-Hospital home health services readmission measure (1) Readmission measure Not later than January 1, 2016, the Secretary shall specify a home health all-cause all-condition hospital unplanned readmission measure (or any successor to such a measure) for readmissions (for any cause) to a hospital for an individual who is entitled to benefits under part A (or enrolled under part B) and who is receiving post-hospital home health services. (2) Resource use measure Not later than January 1, 2017, the Secretary shall specify a measure that is the measure specified under paragraph (1), risk-adjusted for potentially preventable readmissions to a hospital for an individual described in such paragraph. (3) Development The measures specified under paragraphs (1) and (2) shall be developed through a formal process that is based on input from a group of multiple stakeholders consisting of at least senior advocates, Medicare beneficiaries, caregivers, and home health physicians, nurses, therapists, and operators of home health agencies. (4) Quarterly feedback reports to home health agencies Beginning January 1, 2017, and every quarter thereafter, the Secretary shall provide confidential feedback to home health agencies on their performance with respect to such measures. (5) Public reporting on performance (A) In general Subject to subparagraphs (B) and (C), the Secretary shall establish procedures for making public on the Medicare Home Health Compare website (or successor to such website) the performance of home health agencies with respect to a measure specified under paragraph (1) and a measure specified under paragraph (2). (B) Opportunity to review The procedures under subparagraph (A) shall ensure that a home health agency has the opportunity to review and submit corrections to the information that is to be made public with respect to such agency before such information is made public. (C) Timing Such procedures shall provide that the information described in subparagraph (A) is first made publicly available beginning no later than January 1, 2018. . (b) Value-Based purchasing program for home health agencies Section 1895 of the Social Security Act ( 42 U.S.C. 1395fff ), as amended by subsection (a), is further amended by adding at the end the following new subsection: (g) Application of value-Based purchasing program (1) Establishment (A) In general Subject to the succeeding provisions of this subsection, the Secretary shall establish a home health agency value-based purchasing program (in this subsection referred to as the HHA VBP Program ) under which value-based incentive payments are made in a year to home health agencies. (B) Program to begin in 2019 The HHA VBP Program shall apply to payments for episodes of home health services beginning on or after January 1, 2019. (2) Application of measures — (A) In general Subject to subparagraph (B), the Secretary shall apply the measure specified under subsection (f)(2) for purposes of the HHA VBP Program. (B) Replacement If the Secretary determines that the application of such measure is not practicable and should be delayed and the Secretary notifies the Committee on Finance of the Senate and the Committees on Ways and Means and Energy and Commerce of the House of Representatives of the reasons for such delay in advance of implementing such delay, the Secretary may delay the application of such measure for a period of up to 1 year. For the period of any such delay, the measure specified under subsection (f)(1) shall apply for purposes of the HHA VBP Program instead of the measure specified under subsection (f)(2). (3) Performance standards (A) Establishment The Secretary shall establish performance standards with respect to the measure applied under paragraph (2) for a performance period for a year. (B) Higher of achievement and improvement The performance standards established under subparagraph (A) shall include levels of achievement and improvement. In calculating the HHA performance score under paragraph (4), the Secretary shall use the higher of either improvement or achievement. (C) Timing The Secretary shall establish and announce the performance standards established under subparagraph (A) not later than 60 days before the beginning of the performance period for the year involved. (4) HHA performance score (A) In general The Secretary shall develop by regulation a methodology for assessing the total performance of each home health agency based on performance standards established under paragraph (3) with respect to the measure applied under paragraph (2). Using such methodology, the Secretary shall provide for an assessment (in this subsection referred to as the HHA performance score ) for each home health agency for each such performance period. (B) Ranking of hha performance scores The Secretary shall, for the performance period for each year, rank the HHA performance scores determined under subparagraph (A) from low to high. (5) Budget neutral withholding The Secretary shall withhold from the payment rates made for each year (during the period beginning with 2019 and ending with 2024) for home health services under this section such withholding percentage as is necessary so that the enactment of the Securing Access Via Excellence for Medicare Home Health Act of 2014 is estimated not to result in any net change in payments made for such services under this title. (6) Value-based incentive payment percentage The Secretary shall provide for a distribution of a portion of the amounts withheld under paragraph (5) for performance payments to home health agencies in a manner so as to ensure that— (A) the distribution (expressed as a percentage of such withheld amounts) is based on each agency’s HHA performance ranking under paragraph (4)(B) for the performance period for the year involved; (B) the application of all such percentages in such year results in an appropriate distribution of value-based incentive payments under this subsection such that— (i) home health agencies with the highest rankings under paragraph (4)(B) receive the highest value-based incentive payment amounts under this subsection; (ii) home health agencies with the lowest rankings under paragraph (4)(B) receive the lowest value-based incentive payment amounts under this subsection; and (iii) in the case of home health agencies in the lowest 40 percent of the ranking under paragraph (4)(B), the payment rate under this subsection for services furnished by such facility during such year shall be less than the payment rate for such services for such year that would otherwise apply without application of this subsection; and (C) the total amount of value-based incentive payments under this subsection for all home health agencies in such year shall be greater than or equal to 50 percent, but not greater than 70 percent, of the total amount of the payments withheld for such year under paragraph (5), as estimated by the Secretary. (7) Announcement of result of adjustments Under the HHA VBP program, the Secretary shall, not later than 60 days before a year involved, inform each home health agency of the adjustments to payments to the agency for services furnished by the agency during the year under this subsection. (8) No effect in subsequent year The value-based payment adjustments under this subsection shall only apply with respect to the year involved, and the Secretary shall not take into account such adjustment in making payments to a home health agency under this section in a subsequent year. (9) Funding for program management The Secretary shall provide for the one-time transfer from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 to the Centers for Medicare & Medicaid Services Program Management Account of— (A) $2,000,000 for purposes of subsection (f); and (B) $10,000,000 for purposes of implementing this subsection. Such funds shall remain available until expended. . (c) MedPAC Study Not later than June 30, 2021, the Medicare Payment Advisory Commission shall submit to Congress a report that reviews the progress of the home health value-based purchasing program established under section 1895(g) of the Social Security Act, as added by subsection (b), and makes recommendations, as appropriate, on any improvements that should be made to such program. For purposes of the previous sentence, the Medicare Payment Advisory Commission shall consider any unintended consequences with respect to such home health agency value-based purchasing program and any potential adjustments to the readmission measure specified under section 1895(f) of such Act, as added by subsection (a), for purposes of determining the effect of the socio-economic status of a beneficiary under the Medicare program under title XVIII of the Social Security Act on the performance score of a home health agency provided under section 1895(g)(4) of such Act, as added by subsection (b).