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SECTION 1. SHORT TITLE.

This Act may be cited as the ''The Fairness in Medicare Home Health
Access Act of 1999''.

SEC. 2. FINDINGS AND PURPOSES.

(a) Findings.--Congress finds the following:
(1) Home health care is a vital component of the medicare
program under title XVIII of the Social Security Act.
(2) Home health services provided under the medicare
program enable medicare beneficiaries who are homebound and
greatly risk costly institutionalized care to continue to live
in their own homes and communities.
(3) Implementation of the interim payment system for home
health services has inadvertently exacerbated payment
disparities for home health services among regions, penalizing
efficient, low-cost providers in rural areas and providing
insufficient compensation for the care of medicare
beneficiaries with acute, medically complex conditions.
(4) The combination of insufficient payments and new
administrative changes has reduced the access of medicare
beneficiaries to home health services in many areas by forcing
home health agencies to provide fewer services, to shrink their
service areas, or to limit the types of conditions for which
they provide treatment.
(b) Purposes.--The purposes of this Act are as follows:
(1) To improve access to care for medicare beneficiaries
with high medical needs by establishing a process for home
health agencies to exclude services provided to medicare
beneficiaries with acute, medically complex conditions from
payment limits and to receive payment based on the reasonable
costs of providing such services through a process that is
feasible for the Health Care Financing Administration to
administer.
(2) To ensure that the 15 percent contingency reduction in
medicare payments for home health services established under
the Balanced Budget Act of 1997 does not occur under the
interim payment system for home health services.
(3) To reduce the scheduled 15 percent reduction in the
cost limits and per beneficiary limits to 10 percent and to
phase-in the additional 5 percent reduction in such limits
after the initial 3 years of the prospective payment system for
home health services.
(4) To address the unique challenges of serving medicare
beneficiaries in rural and underserved areas by increasing the
per visit cost limit under the interim payment system for home
health services.
(5) To refine the home health consolidated billing
provision to ensure that medicare beneficiaries requiring
durable medical equipment services do not experience a break in
the continuum of care during episodes of home health care.
(6) To eliminate the requirement that home health agencies
identify the length of time of a service visit in 15 minute
increments.
(7) To express the sense of the Senate that the Secretary
of Health and Human Services should establish a uniform process
for disseminating information to fiscal intermediaries to
ensure timely and accurate information to home health agencies
and beneficiaries.

SEC. 3. ADEQUATELY ACCOUNTING FOR THE NEEDS OF MEDICARE BENEFICIARIES
WITH ACUTE, MEDICALLY COMPLEX CONDITIONS.

(a) Waiver of Per Beneficiary Limits for Outliers.--Section
1861(v)(1)(L) of the Social Security Act (42 U.S.C. 1395x(v)(1)(L)), as
amended by section 5101 of the Tax and Trade Relief Extension Act of
1998 (contained in Division J of Public Law 105-277), is amended--
(1) by redesignating clause (ix) as clause (x); and
(2) by inserting after clause (viii) the following:
''(ix)(I) Notwithstanding the applicable per beneficiary limit
under clause (v), (vi), or (viii), but subject to the applicable per
visit limit under clause (i), in the case of a provider that
demonstrates to the Secretary that with respect to an individual to
whom the provider furnished home health services appropriate to the
individual's condition (as determined by the Secretary) at a reasonable
cost (as determined by the Secretary), and that such reasonable cost
significantly exceeded such applicable per beneficiary limit because of
unusual variations in the type or amount of medically necessary care
required to treat the individual, the Secretary, upon application by
the provider, shall pay to such provider for such individual such
reasonable cost.
''(II) The total amount of the additional payments made to home
health agencies pursuant to subclause (I) in any fiscal year shall not
exceed an amount equal to 2 percent of the amounts that would have been
paid under this subparagraph in such year if this clause had not been
enacted.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of enactment of this Act, and apply with
respect to each application for payment of reasonable costs for
outliers submitted by any home health agency for cost reporting periods
ending on or after October 1, 1999.

SEC. 4. PROTECTION OF THE ACCESS OF MEDICARE BENEFICIARIES TO HOME
HEALTH SERVICES BY ADDRESSING THE 15 PERCENT CONTINGENCY
REDUCTION IN INTERIM PAYMENTS FOR HOME HEALTH SERVICES.

(a) Elimination of Contingency Reduction.--Section 4603 of the
Balanced Budget Act of 1997 (42 U.S.C. 1395fff note), as amended by
section 5101(c)(3) of the Tax and Trade Relief Extension Act of 1998
(contained in division J of Public Law 105-277), is amended by striking
subsection (e).
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as if included in the enactment of the Balanced Budget Act
of 1997 (Public Law 105-33; 111 Stat. 251).

SEC. 5. PROTECTION OF THE ACCESS OF MEDICARE BENEFICIARIES TO HOME
HEALTH SERVICES THROUGH A PHASE-IN OF THE 15 PERCENT
REDUCTION IN PROSPECTIVE PAYMENTS FOR HOME HEALTH
SERVICES.

(a) Phase-In of 15 Percent Reduction.--Section 1895(b)(3)(A)(ii)
(42 U.S.C. 1395fff(b)), as amended by section 5101(c)(1)(B) of the Tax
and Trade Relief Extension Act of 1998 (contained in division J of
Public Law 105-277), is amended--
(1) in paragraph (3)(A)(ii), by striking ''15'' and
inserting ''10''; and
(2) by adding at the end the following:
''(7) Special rule for payments beginning with fiscal year
2004.--Beginning with fiscal year 2004, payment under this
section shall be made as if '15' had been substituted for '10'
in clause (ii) of paragraph (3)(A) when computing the initial
basis under such paragraph.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of enactment of this Act.

SEC. 6. INCREASE IN PER VISIT COST LIMIT TO 112 PERCENT OF THE NATIONAL
MEDIAN.

Section 1861(v)(1)(L)(i) of the Social Security Act (42 U.S.C.
1395x(v)(1)(L)(i)), as amended by section 5101(b) of the Tax and Trade
Relief Extension Act of 1998 (contained in division J of Public Law
105-277), is amended--
(1) in subclause (IV), by striking ''or'';
(2) in subclause (V)--
(A) by inserting ''and before October 1, 1999,''
after ''October 1, 1998,''; and
(B) by striking the period and inserting '', or'';
and
(3) by adding at the end the following:
''(VI) October 1, 1999, 112 percent of such median.''.

SEC. 7. REFINEMENT OF HOME HEALTH AGENCY CONSOLIDATED BILLING.

(a) In General.--Section 1842(b)(6)(F) of the Social Security Act
(42 U.S.C. 1395u(b)(6)(F)) is amended by striking ''payment shall be
made to the agency (without regard to whether or not the item or
service was furnished by the agency, by others under arrangement with
them made by the agency, or when any other contracting or consulting
arrangement, or otherwise).'' and inserting ''(i) payment shall be made
to the agency (without regard to whether or not the item or service was
furnished by the agency, by others under arrangement with them made by
the agency, or when any other contracting or consulting arrangement, or
otherwise); and (ii) in the case of an item of durable medical
equipment (as defined in section 1861(n)), payment for the item shall
be made to the agency separately from payment for other items and
services furnished to such an individual under such plan.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to items of durable medical equipment furnished on or after the
date of enactment of this Act.

SEC. 8. ELIMINATION OF TIMEKEEPING REQUIREMENTS UNDER THE PROSPECTIVE
PAYMENT SYSTEM FOR HOME HEALTH AGENCIES.

(a) In General.--Section 1895(c) of the Social Security Act (42
U.S.C. 1395fff(c)) is amended--
(1) by striking ''unless--'' and all that follows through
''(1) the'' and inserting ''unless the''; and
(2) by striking ''1835(a)(2)(A);'' and all that follows
through the period and inserting ''1835(a)(2)(A).''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date of enactment of this Act.

SEC. 9. SENSE OF THE SENATE REGARDING THE TIMELINESS AND ACCURACY OF
INTERMEDIARY COMMUNICATIONS TO HOME HEALTH AGENCIES.

It is the sense of the Senate that the Secretary of Health and
Human Services should establish a nationally uniform process that
ensures that each fiscal intermediary (as defined in section 1816(a) of
the Social Security Act (42 U.S.C. 1395h(a))) and each carrier (as
defined in section 1842(f) of such Act (42 U.S.C. 1395u(f))) has the
training and ability necessary to provide timely, accurate, and
consistent coverage and payment information to each home health agency
and to each individual eligible to have payment made under the medicare
program under title XVIII of such Act (42 U.S.C. 1395 et seq.).
Amends the Balanced Budget Act of 1997 to eliminate the 15 percent home health services payment reduction in interim payments which would occur if the Secretary did not establish a prospective payment system (PPS) for such services as provided for in such Act.
Amends SSA title XVIII with regard to the PPS for home health services to reduce the current 15 percent reduction in cost and per beneficiary limits to ten percent, establishing a special rule beginning in FY 2004 that restores the reduction back to its original 15 percent.
Increases the per visit cost limit to 112 percent of the national median.
Provides that in the case of home health services furnished to an individual who (at the time of furnishing) is under a home health agency plan of care, payment for an item of durable medical equipment shall be made to the agency separately from payment for other items and services furnished.
Eliminates timekeeping requirements under the PPS for home health agencies.
Expresses the sense of the Senate that the Secretary should establish a nationally uniform process that ensures that fiscal intermediaries and carriers under Medicare have the training and ability necessary to provide timely, accurate, and consistent coverage and payment information to each home health agency and to each individual eligible to have payment made under Medicare.