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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Home Health Access Preservation Act
of 1998''.

SEC. 2. REVISION OF PER BENEFICIARY LIMIT.

(a) In General.--
(1) In general.--Section 1861(v)(1)(L) of the Social
Security Act (42 U.S.C. 1395x(v)(1)(L)) (as amended by section
4602(c) of the Balanced Budget Act of 1997) is amended--
(A) by amending clause (v) to read as follows:
''(v) For services furnished by home health agencies for cost
reporting periods beginning on or after October 1, 1998, the Secretary
shall provide for an interim system of limits. Payment shall not exceed
the costs determined under the preceding provisions of this
subparagraph or, if lower, the product of--
''(I) the agency-specific per beneficiary annual limitation
(as determined under clause (viii)) (which is calculated based
50 percent on the national average of all payments under this
title for home health services per person served during
calendar year 1994 and 50 percent on the average of all
payments under this title for home health services per person
served in the agency's census division in calendar year 1994);
and
''(II) the agency's unduplicated census count of patients
(entitled to benefits under this title) for the cost reporting
period subject to the limitation.''; and
(B) by adding at the end the following:
''(viii) For purposes of clause (v)(I), the agency-specific per
beneficiary annual limitation is the following amount (adjusted by the
area wage index applicable under section 1886(d)(3)(E) and determined
in the manner described in clause (iii)):
''(I) For an agency located in the New England census
division (Connecticut, Maine, Massachusetts, New Hampshire,
Rhode Island, and Vermont), $4,019.50.
''(II) For an agency located in the Middle Atlantic census
division (New Jersey, New York, and Pennsylvania), $3,523.50.
''(III) For an agency located in the East North Central
census division (Illinois, Indiana, Michigan, Ohio, and
Wisconsin), $3,644.00.
''(IV) For an agency located in the West North Central
census division (Iowa, Kansas, Minnesota, Montana, Nebraska,
North Dakota, and South Dakota), $3,443.50.
''(V) For an agency located in the South Atlantic census
division (Delaware, the District of Columbia, Florida, Georgia,
Maryland, North Carolina, South Carolina, Virginia, and West
Virginia), $4,041.00.
''(VI) For an agency located in the East South Central
census division (Alabama, Kentucky, Mississippi, and
Tennessee), $4,672.50.
''(VII) For an agency located in the West South Central
census division (Arkansas, Louisiana, Oklahoma, and Texas),
$4,946.50.
''(VIII) For an agency located in the Mountain census
division (Arizona, Colorado, Idaho, Montana, Nevada, New
Mexico, Utah, and Wyoming), $4,033.00.
''(IX) For an agency located in the Pacific census division
(Alaska, California, Hawaii, Oregon, and Washington),
$3,939.00.''.
(2) Conforming amendments.--Section 1861(v)(1)(L)(vi) of
the Social Security Act (42 U.S.C. 1395x(v)(1)(L)(vi)) (as
added by section 4602(c) of the Balanced Budget Act of 1997) is
amended--
(A) by striking ''For services'' and inserting ''In
the case of services''; and
(B) by striking ''the following rules apply''
through ''For beneficiaries'' and inserting ''for
beneficiaries''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on October 1, 1998.

SEC. 3. INCREASED PAYMENTS FOR HOME HEALTH AGENCIES THAT PROVIDE
SERVICES TO CERTAIN BENEFICIARIES.

(a) Estimate.--The Secretary of Health and Human Services (in this
section referred to as the ''Secretary'') shall estimate the amount of
savings (if any) to the Medicare Program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.) resulting from the
provisions in this Act for each fiscal year beginning after fiscal year
1998 and before the first fiscal year in which the prospective payment
system for home health agencies (established by section 1895 of such
Act (42 U.S.C. 1395fff)) applies. Each such estimate shall be made not
later than the first day of the fiscal year, except that in the case of
fiscal year 1999, such estimate shall be made not later than the 30th
day after the date of enactment of this Act.
(b) Increased Payments.--
(1) In general.--If the Secretary estimates that there will
be savings to the Medicare Program pursuant to subsection (a)
in a fiscal year, the Secretary shall prescribe rules under
which the amount of payments to a home health agency otherwise
made for such year under the Medicare Program is increased by a
specific amount (determined by the Secretary in regulations)
for each beneficiary that has been a patient of such agency for
at least 120 consecutive days during such year. The total
amount of increased payments made under this section in a
fiscal year shall equal the estimated savings for such year.
(2) Determination of increased payment.--Not later than
October 1 of each year (beginning in 1998), the Secretary shall
establish the increased payment amount for purposes of
paragraph (1) that is applicable for the fiscal year beginning
on such date. In the case of fiscal year 1999, the Secretary
shall establish such increased payment amount by not later than
the 30th day after the date of enactment of this Act.
(c) Heightened Scrutiny of Certain Claims.--The Secretary shall
establish procedures to provide heightened scrutiny of claims for
reimbursement under the Medicare Program for items and services
provided to beneficiaries described in subsection (b)(1).

SEC. 4. INCREASE IN PER-VISIT COST LIMITS.

(a) In General.--Section 1861(v)(1)(L)(i)(IV) of the Social
Security Act (42 U.S.C. 1395x(v)(1)(L)(i)(IV)) (as added by section
4602 of the Balanced Budget Act of 1997) is amended by striking ''105
percent'' and inserting ''108 percent''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on October 1, 1998.

SEC. 5. UPDATE ON IMPLEMENTATION OF PROSPECTIVE PAYMENT SYSTEM FOR HOME
HEALTH AGENCIES.

Not later than 90 days after the date of enactment of this Act, and
every 90 days thereafter until the prospective payment system for home
health agencies (established by section 1895 of the Social Security Act
(42 U.S.C. 1395fff)) is implemented, the Secretary of Health and Human
Services shall meet with the staff of the appropriate committees of
Congress to provide an informal update regarding the progress of the
Secretary in implementing such payment system.
Home Health Access Preservation Act of 1998 - Amends title XVIII (Medicare) of the Social Security Act (SSA), as amended by the Balanced Budget Act of 1997, with respect to the computation formula of the interim system of limited payments for services provided by home health agencies, in order to mandate a new interim system, as of October 1, 1998, with a revised formula and specific amounts for the agency-specific per beneficiary annual limitation, according to the census division in which an agency is located.
Directs the Secretary of Health and Human Services to: (1) estimate the amount of savings (if any) to Medicare resulting from this Act for each fiscal year beginning after FY 1998 and before the first fiscal year in which the prospective payment system (PPS) for home health agencies applies; (2) prescribe rules for increased payments to such an agency, if there will be estimated savings; and (3) establish procedures to provide heightened scrutiny of claims for reimbursement under Medicare for items and services provided to certain agency beneficiaries.
Amends SSA title XVIII to provide for a three percent increase in per visit cost limits for cost reporting periods beginning on or after October 1, 1997.
Directs the Secretary to meet every 90 days with appropriate congressional committee staff to provide informal updates of progress in implementing the PPS above.