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SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ''Medicare Home
Health Refinement Act of 2000''.
(b) Table of Contents.--The table of contents of this Act is as
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--EMERGENCY CASH-FLOW ASSISTANCE FOR HOME HEALTH AGENCIES

Sec. 101. Home Health Transitional Loan Program.
Sec. 102. Establishment of split-payment percentages under the PPS for
home health services.
Sec. 103. Prompt payment from medicare trust funds under the IPS and
the PPS for home health services.
TITLE II--REIMBURSEMENT OF HOME HEALTH AGENCIES FOR UNFUNDED PPS
RELATED COSTS

Sec. 201. Adjustment to reflect administrative costs not included in
the PPS for home health services.
TITLE III--REIMBURSEMENT OF HOME HEALTH AGENCIES FOR OASIS LABOR COSTS

Sec. 301. Reimbursement for OASIS labor costs under the IPS and PPS for
home health services.
TITLE IV--NONROUTINE MEDICAL SUPPLIES FURNISHED BY HOME HEALTH AGENCIES

Sec. 401. Exclusion of nonroutine medical supplies under the PPS for
home health services.

SEC. 2. FINDINGS.

Congress makes the following findings:
(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) The Balanced Budget Act of 1997 reformed Medicare home
health care spending by instructing the Health Care Financing
Administration (in this section referred to as ''HCFA'') to
implement a prospective payment system.
(4) A number of HCFA's regulations to implement the
prospective payment system are administratively burdensome and
divert funds away from needed beneficiary care.
(5) The vast majority of home health agencies are small
businesses or nonprofit institutions that cannot operate with
significant cash flow problems.
(6) The prospective payment system should not penalize home
health agencies that treat medicare beneficiaries with higher-
than-average medical needs.

TITLE I--EMERGENCY CASH-FLOW ASSISTANCE FOR HOME HEALTH AGENCIES

SEC. 101. HOME HEALTH TRANSITIONAL LOAN PROGRAM.

(a) Establishment of Home Health Transitional Loan Program.--There
is established a Home Health Transitional Loan Program under which the
Secretary of Health and Human Services (in this section referred to as
the ''Secretary'') shall make loans from the Federal Hospital Insurance
Trust Fund to any qualified home health agency (as defined in
subsection (c)) in accordance with the terms and conditions described
in subsection (b) before the termination of the authority of the
Secretary to make such loans under subsection (d).
(b) Terms and Conditions.--
(1) In general.--Subject to paragraph (2), the Secretary
shall make loans on such terms and conditions as the Secretary
may specify.
(2) Specific terms and conditions.--The terms and
conditions of each loan shall include the following:
(A) Application.--The Secretary shall approve each
application for a loan under this section submitted by
a qualified home health agency not later than 10 days
after the Secretary receives such application.
(B) Amount.--The total amount of a loan made to a
qualified home health agency under this section may not
exceed the average total costs incurred by such a home
health agency during a 3-month period as reported on
such home health agency's most recently settled
medicare cost report.
(C) Interest rate.--The interest rate of the loans
made under this section shall be zero percent.
(D) Duration.--The home health agency shall repay
any loan made under this section not later than 12
months after the date on which such loan is made.
(c) Qualified Home Health Agency Defined.--The term ''qualified
home health agency'' means a home health agency (as defined in section
1861(o) of the Social Security Act (42 U.S.C. 1395x(o))) that the
Secretary determines does not have sufficient cash reserves to
transition from the interim payment system for home health services
under section 1861(v)(1)(L) of such Act (42 U.S.C. 1395x(v)(1)(L)) (in
this section referred to as the ''IPS'' to the prospective payment
system for such services under section 1895 of such Act (42 U.S.C.
1395fff) (in this section referred to as the ''PPS'') because of--
(1) the repayment by the home health agency of overpayments
made under the IPS;
(2) the discontinuation of the periodic interim payment for
home health agencies by section 4603(b) of the Balanced Budget
Act of 1997 (Public Law 105-133; 111 Stat. 470); or
(3) the payment amounts under the PPS being less than the
payment amounts under the IPS.
(d) Termination of Authority.--The Secretary may not make any loan
under this section after the date that is 6 months after the date of
enactment of this Act.
(e) Effective Date.--This section shall take effect on the later
of--
(1) the date of enactment of this Act; or
(2) the date on which the Secretary implements the
prospective payment system under section 1895 of the Social
Security Act (42 U.S.C. 1395fff).

SEC. 102. ESTABLISHMENT OF SPLIT-PAYMENT PERCENTAGES UNDER THE PPS FOR
HOME HEALTH SERVICES.

(a) Establishment.--Section 1895(b) of the Social Security Act (42
U.S.C. 1395fff) is amended by adding at the end the following new
paragraph:
''(7) Establishment of split-payment percentages.--In
making payments under this section, the Secretary shall pay to
the agency 80 percent of the prospective payment amount upon
the transmittal of the notice of patient admission and 20
percent of such amount upon transmittal of the final episode
claim.''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of enactment of this Act.

SEC. 103. PROMPT PAYMENT FROM MEDICARE TRUST FUNDS UNDER THE IPS AND
THE PPS FOR HOME HEALTH SERVICES.

(a) Under the IPS.--Section 1861(v)(1)(L) of the Social Security
Act (42 U.S.C. 1395x(v)(1)(L)) is amended by adding at the end the
following new clause:
''(xi) To ensure that payment of claims of home health agencies are
not delayed because the Secretary must determine from which trust fund
to pay a claim under this subparagraph, the Secretary shall pay the
full amount of each claim for an episode of care from the Federal
Supplementary Medical Insurance Trust Fund, and, in the case that any
amount paid from such Trust Fund should have been paid from the Federal
Hospital Insurance Trust Fund, the Secretary shall transfer such amount
from the Federal Hospital Insurance Trust Fund to the Federal
Supplementary Medical Insurance Trust Fund.''.
(b) Under the PPS.--Section 1895(b) of the Social Security Act (42
U.S.C. 1395fff) (as amended by section 102) is amended by adding at the
end the following new paragraph:
''(8) Prompt payments from trust funds.--To ensure that
payment of claims of home health agencies are not delayed
because the Secretary must determine from which trust fund to
pay a claim under this section, the Secretary shall pay the
full amount of each claim for an episode of care from the
Federal Supplementary Medical Insurance Trust Fund, and, in the
case that any amount paid from such Trust Fund should have been
paid from the Federal Hospital Insurance Trust Fund, the
Secretary shall transfer such amount from the Federal Hospital
Insurance Trust Fund to the Federal Supplementary Medical
Insurance Trust Fund.''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.

TITLE II--REIMBURSEMENT OF HOME HEALTH AGENCIES FOR UNFUNDED PPS
RELATED COSTS

SEC. 201. ADJUSTMENT TO REFLECT ADMINISTRATIVE COSTS NOT INCLUDED IN
THE PPS FOR HOME HEALTH SERVICES.

(a) Adjustment To Reflect Administrative Costs.--In the case of a
home health agency that furnishes home health services to a medicare
beneficiary, for each such beneficiary to whom the agency furnished
such services during the agency's cost reporting period beginning in
fiscal year 2000, the Secretary of Health and Human Services shall pay
the agency, in addition to any amount of payment made under section
1861(v)(1)(L) of the Social Security Act (42 U.S.C. 1395x(v)(1)(L)) for
the beneficiary and only for such cost reporting period, an aggregate
amount of $10 to defray costs incurred by the agency attributable to
technology costs required for compliance with the prospective payment
system for home health services under section 1895 of the Social
Security Act (42 U.S.C. 1395fff), including the acquisition of computer
hardware and software necessary for classification of patients, and
accounting, billing, and transmitting data in the manner required under
such payment system.
(b) Payment 30 Days After Settled Cost Report.--The Secretary shall
pay the amounts payable to an agency under this section no later than
30 days after the later of--
(1) the date of enactment of this Act; or
(2) the date on which the cost report submitted by the
agency for the cost reporting period beginning in fiscal year
2000 is settled.
(c) Payment From Medicare Trust Funds.--Payments under this section
shall be made, in appropriate part as specified by the Secretary, from
the Federal Hospital Insurance Trust Fund and from the Federal
Supplementary Medical Insurance Trust Fund.
(d) Definitions.--In this section:
(1) Home health agency.--The term ''home health agency''
has the meaning given that term under section 1861(o) of the
Social Security Act (42 U.S.C. 1395x(o)).
(2) Home health services.--The term ''home health
services'' has the meaning given that term under section
1861(m) of such Act (42 U.S.C. 1395x(m)).
(3) Medicare beneficiary.--The term ''medicare
beneficiary'' means a beneficiary described in section
1861(v)(1)(L)(vi)(II) of the Social Security Act (42 U.S.C.
1395x(v)(1)(L)(vi)(II)).

TITLE III--REIMBURSEMENT OF HOME HEALTH AGENCIES FOR OASIS LABOR COSTS

SEC. 301. REIMBURSEMENT FOR OASIS LABOR COSTS UNDER THE IPS AND PPS FOR
HOME HEALTH SERVICES.

(a) Adjustment To Reflect Administrative Costs.--
(1) Under the interim payment system.--Section 301(a) of
the Medicare, Medicaid, and SCHIP Balanced Budget Refinement
Act of 1999 (42 U.S.C. 1395fff note) is amended--
(A) in paragraph (1)--
(i) by inserting ''and each subsequent
fiscal year before the implementation of the
prospective payment system under section 1895
of the Social Security Act (42 U.S.C.
1395fff)'' after ''beginning in fiscal year
2000''; and
(ii) by striking ''$10'' and inserting
''$30'';
(B) in paragraph (2)--
(i) by redesignating subparagraphs (A) and
(B) as clauses (i) and (ii), respectively;
(ii) by inserting after the heading the
following:
''(A) For fiscal year 2000.--''; and
(iii) by adding at the end the following
new subparagraph:
''(B) For subsequent fiscal years.--For each cost
reporting period beginning after fiscal year 2000 and
before the implementation of the prospective payment
system under section 1895 of the Social Security Act
(42 U.S.C. 1395fff), the Secretary shall pay the
amounts payable to an agency under this subsection no
later than 30 days after the date on which the cost
report submitted by the agency for the cost reporting
period beginning in such fiscal year is settled.''.
(2) Under the prospective payment system.--Section 1895(b)
of the Social Security Act (42 U.S.C. 1395fff) (as amended by
section 103) is amended by adding at the end the following new
paragraph:
''(9) Adjustment to reflect oasis administrative costs.--In
the case of a home health agency that furnishes home health
services to a medicare beneficiary, for each such beneficiary
to whom the agency furnished such services during the agency's
cost reporting period for which payment is made to such agency
under this section, the Secretary shall include in such payment
an aggregate amount of $30 to defray costs incurred by the
agency attributable to data collection and reporting
requirements under the Outcome and Assessment Information Set
(OASIS) required by reason of section 4602(e) of BBA (42 U.S.C.
1395fff note).
(b) Waiving Budget Neutrality.--Section 1895(b)(3) of such Act (42
U.S.C. 1395fff(b)(3)) is amended by adding at the end the following new
subparagraph:
''(D) No adjustment for additional payments for
oasis administrative costs.--The Secretary shall not
reduce the standard prospective payment amount (or
amounts) under this paragraph applicable to home health
services furnished during a period to offset the
increase in payments resulting from the application of
paragraph (9).''.
(c) Effective Date.--The amendments made by subsection (a) shall
take effect as if included in the enactment of the Medicare, Medicaid,
and SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-358),
as enacted into law by section 1000(a)(6) of Public Law (106-113).

TITLE IV--NONROUTINE MEDICAL SUPPLIES FURNISHED BY HOME HEALTH AGENCIES

SEC. 401. EXCLUSION OF NONROUTINE MEDICAL SUPPLIES UNDER THE PPS FOR
HOME HEALTH SERVICES.

(a) In General.--Section 1895 of the Social Security Act (42 U.S.C.
1395fff) is amended by adding at the end the following new subsection:
''(e) Exclusion of Nonroutine Medical Supplies.--
''(1) In general.--Notwithstanding the preceding provisions
of this section, in the case of all nonroutine medical supplies
(as defined by the Secretary) furnished by a home health agency
during a year (beginning with 2001) for which payment is
otherwise made on the basis of the prospective payment amount
under this section, payment under this section shall instead be
based on the lesser of--
''(A) the actual charge for the nonroutine medical
supply, or
''(B) the amount determined under the fee schedule
established by the Secretary for purposes of making
payment under this subsection for nonroutine medical
supplies furnished during that year.
''(2) Budget neutrality adjustment.--The Secretary shall
provide for an appropriate proportional reduction in payments
under this section so that beginning with fiscal year 2001, the
aggregate amount of such reductions is equal to the aggregate
increase in payments attributable to the exclusion effected
under paragraph (1).''.
(b) Conforming Amendment.--Section 1895(b)(1) of the Social
Security Act (42 U.S.C. 1395fff(b)(1)) is amended by striking ''The
Secretary'' and inserting ''Subject to subsection (e), the Secretary''.
(c) Effective Date.--The amendments made by this section shall take
effect on the date of enactment of this Act.
Title II: Reimbursement of Home Health Agencies for Unfunded PPS Related Costs
- Provides that in the case of a home health agency that furnishes home health services to a Medicare beneficiary, for each such beneficiary to whom the agency furnished such services during the agency's cost reporting period beginning in FY 2000, the Secretary shall pay the agency a specified amount from the Medicare trust funds to defray costs incurred by it attributable to technology costs required for compliance with the PPS for home health services.
Title III: Reimbursement of Home Health Agencies for OASIS Labor Costs
- Amends the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 to provide for reimbursement for Outcome and Assessment Information Set (OASIS) labor costs under the IPS and PPS for home health services.
Title IV: Nonroutine Medical Supplies Furnished by Home Health Agencies
- Amends SSA title XVIII to: (1) exclude nonroutine medical supplies from the PPS for home health services; and (2) require payment of the lesser of the actual charge for such supplies or the amount determined under a fee schedule.