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

Bill: 115-hr-6932
Sponsor: full_name: Rep. Abraham, Ralph Lee [R-LA-5]
Introduced: 2018-09-27
Policy area: Health
Subjects: Administrative law and regulatory procedures

Department of Health and Human Services

Government information and archives

Health care costs and insurance

Home and outpatient care

Medicare
Latest action: action_date: 2018-10-10
text: Referred to the Subcommittee on Health.

Summaries:
action_date: 2018-09-27
action_desc: Introduced in House
text: <p>This bill 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.</p>

tv_txt: I 115th CONGRESS 2d Session H. R. 6932 IN THE HOUSE OF REPRESENTATIVES September 27, 2018 Mr. Abraham (for himself, Mr. DesJarlais , Mr. Buchanan , Ms. Sewell of Alabama , and Mr. Graves of Louisiana ) 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 improve home health payment reforms under the Medicare program.

1. 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; (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).