[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4229 Introduced in House (IH)]







104th CONGRESS
  2d Session
                                H. R. 4229

    To amend title XVIII of the Social Security Act to provide for 
    prospective payment for home health services under the Medicare 
                    program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 27, 1996

 Mrs. Johnson of Connecticut introduced the following bill; which was 
  referred to the Committee on Ways and Means, and in addition to the 
 Committee on 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 provide for 
    prospective payment for home health services under the Medicare 
                    program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Home Health Services 
Prospective Payment Amendments of 1996''.

SEC. 2. PAYMENT FOR HOME HEALTH SERVICES.

    (a) In General.--Title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.), as amended by section 202 of Public Law 104-191, is 
amended by adding at the end the following new section:

                   ``payment for home health services

    ``Sec. 1894. (a) In General.--Notwithstanding section 1861(v), the 
Secretary shall provide for payments for home health services in 
accordance with a prospective payment system as follows:
            ``(1) Per visit payments.--Subject to subsection (c), the 
        Secretary shall make per visit payments to a home health agency 
        in accordance with this section for each type of home health 
        service described in paragraph (2) furnished to an individual 
        who at the time the service is furnished is under a plan of 
        care by the home health agency under this title (without regard 
        to whether or not the item or service was furnished by the 
        agency or by others under arrangement with them made by the 
        agency, under any other contracting or consulting arrangement, 
        or otherwise).
            ``(2) Types of services.--The types of home health services 
        described in this paragraph are the following:
                    ``(A) Part-time or intermittent nursing care 
                provided by or under the supervision of a registered 
                professional nurse.
                    ``(B) Physical therapy.
                    ``(C) Occupational therapy.
                    ``(D) Speech-language pathology services.
                    ``(E) Medical social services under the direction 
                of a physician.
                    ``(F) To the extent permitted in regulations, part-
                time or intermittent services of a home health aide who 
                has successfully completed a training program approved 
                by the Secretary.
    ``(b) Establishment of Per Visit Rate for Each Type of 
Assistance.--
            ``(1) In general.--The Secretary shall, subject to 
        paragraph (3), establish a per visit payment rate for a home 
        health agency in an area (which shall be the same area used to 
        determine the area wage index applicable to hospitals under 
        section 1886(d)(3)(E)) for each type of home health service 
        described in subsection (a)(2). Such rate shall be equal to the 
        national per visit payment rate determined under paragraph (2) 
        for each such type, except that the labor-related portion of 
        such rate shall be adjusted by the area wage index applicable 
        under section 1886(d)(3)(E) for the area in which the agency is 
        located (as determined without regard to any reclassification 
        of the area under section 1886(d)(8)(B) or a decision of the 
        Medicare Geographic Classification Review Board or the 
        Secretary under section 1886(d)(10) for cost reporting periods 
        beginning after October 1, 1995).
            ``(2) National per visit payment rate.--The national per 
        visit payment rate for each type of service described in 
        subsection (a)(2)--
                    ``(A) for fiscal year 1997, is an amount equal to 
                the national average amount reimbursed per visit under 
                this title to home health agencies for such type of 
                service (including medical supplies) during the most 
                recent 12-month cost reporting period ending on or 
                before December 31, 1994, updated by the home health 
                market basket percentage increase for each year before 
                the date in such fiscal year in which this section 
                first applies; and
                    ``(B) for each subsequent fiscal year, is an amount 
                equal to the national per visit payment rate in effect 
                under this paragraph for the preceding fiscal year, 
                increased by the home health market basket percentage 
                increase for such subsequent fiscal year.
            ``(3) Payments above per visit rates.--
                    ``(A) Election.--A home health agency may elect to 
                receive per visit payments in excess of the per visit 
                payment rate under paragraph (1) up to the per visit 
                payment limit under subparagraph (B) if the agency can 
                demonstrate to the satisfaction of the Secretary that 
                it can reasonably expect to incur such costs and that 
                total payments will not exceed the agency's aggregate 
                limit under subsection (c). The Secretary shall further 
                provide for exemptions, exceptions, and adjustments to 
                the per visit payment limit of this section on the same 
                basis as are provided under subsection (c)(3) with 
                respect to the limitations on final payment.
                    ``(B) Per visit payment limit.--For fiscal year 
                1997, the per visit payment limit under this 
                subparagraph is calculated as established by section 
                1861(v)(1)(L). For each subsequent year, such payment 
                limit is equal to the limit for the preceding fiscal 
                year under this subparagraph increased by the home 
                health market basket index for the fiscal year 
                involved.
            ``(4) Home health market basket percentage increase.--For 
        purposes of this subsection, the term `home health market 
        basket percentage increase' means, with respect to a fiscal 
        year, a percentage (estimated by the Secretary before the 
        beginning of the fiscal year) determined and applied with 
        respect to the types of home health services described in 
        subsection (a)(2) in the same manner as the market basket 
        percentage increase under section 1886(b)(3)(B)(iii) is 
        determined and applied to inpatient hospital services for 
        discharges in the fiscal year.
    ``(c) Aggregate Limits.--
            ``(1) Phase i aggregate limit.--
                    ``(A) In general.--Before the end of the second 12-
                month period beginning on the effective date of this 
                section, except as provided in paragraphs (3) and (4), 
                a home health agency may not receive aggregate per 
                visit payments under subsection (a) for such a 12-month 
                period in excess of an amount equal to the product of--
                            ``(i) the number of unduplicated medicare 
                        beneficiaries receiving home health services 
                        from the agency during the period; and
                            ``(ii) the per patient limit determined for 
                        such period.
                    ``(B) Establishment of per patient limits for 
                initial year.--
                            ``(i) In general.--For the initial 12-month 
                        period, the per patient limit for an agency is 
                        equal to the product of--
                                    ``(I) the sum of 75 percent of the 
                                updated per visit costs described in 
                                clause (ii) for the agency and 25 
                                percent of the regional average 
                                described in clause (iii) for the 
                                agency; and
                                    ``(II) the average annual number of 
                                medicare home health agency visits per 
                                unduplicated medicare beneficiary for 
                                fiscal year 1995.
                            ``(ii) Updated per visit costs.--The 
                        updated per visit costs described in this 
                        clause, for a home health agency for a payment 
                        period, is the average per visit reasonable 
                        costs for home health services of the agency, 
                        calculated for the base year, based on fiscal 
                        year 1994 cost per visit, updated by the home 
                        health market basket percentage increase 
                        through the payment period involved.
                            ``(iii) Regional average.--The regional 
                        average described in this clause, for a home 
                        health agency for a payment period, is the 
                        average of the updated per visit costs 
                        described in clause (ii) for the period for 
                        home health agencies located in the same census 
                        region in which the agency is located.
                    ``(C) Establishment of per patient limits for 
                second year.--For the second 12-month period, the per 
                patient limit for an agency is equal to the product 
                of--
                            ``(i) the sum of--
                                    ``(I) 50 percent of the updated per 
                                visit costs described in subparagraph 
                                (B)(ii) for the agency for the period, 
                                and
                                    ``(II) 50 percent of the regional 
                                average described in subparagraph 
                                (B)(iii) for the agency for the period; 
                                and
                            ``(ii) the average annual number of 
                        medicare home health agency visits per 
                        unduplicated medicare beneficiary for fiscal 
                        year 1995.
                    ``(D) New providers and providers without base 
                year.--For a new home health agency or a home health 
                agency for which there is no base year under 
                subparagraph (B)(ii), the per patient limit shall be 
                equal to the mean of these limits applied to home 
                health agencies in the same census region in which the 
                agency is located as determined by the Secretary. A 
                home health agency shall not be treated as a new home 
                health agency by reason of any corporate restructuring 
                or change of name.
            ``(2) Phase ii aggregate limits.--
                    ``(A) In general.--After the end of the second 12-
                month period beginning on the effective date of this 
                section and until the effective date of any episodic 
                prospective payment system (including a system 
                developed under subsection (h)) that is enacted by the 
                Congress, except as provided in paragraphs (3) and (4), 
                a home health agency may not receive aggregate per 
                visit payments under subsection (a) for a 12-month 
                payment period in excess of an amount equal to the sum 
                of the following:
                            ``(i) The sum (for all case-mix categories) 
                        of the products (determined separately for each 
                        such category) of--
                                    ``(I) the total number of episodes 
                                for the category for which the agency 
                                receives payments during the payment 
                                period, and
                                    ``(II) the per episode limit 
                                determined under subparagraph (B) for 
                                the category and payment year.
                            ``(ii) The product of--
                                    ``(I) the number of unduplicated 
                                medicare beneficiaries receiving home 
                                health services from the agency beyond 
                                120 days during the payment year, and
                                    ``(II) the per patient limit for 
                                services provided beyond 120 days, as 
                                specified in subparagraph (E).
                    ``(B) Establishment of per episode limits for first 
                120 days.--
                            ``(i) In general.--The per episode limit 
                        under this subparagraph for a payment year for 
                        a case-mix category for the area in which a 
                        home health agency is located (which shall be 
                        the same area used to determine the area wage 
                        index applicable to hospitals under section 
                        1886(d)(3)(E)) is equal to the product of--
                                    ``(I) the mean number of visits for 
                                each type of home health service 
                                described in subsection (a)(2) 
                                furnished during an episode of such 
                                case-mix category in such area during 
                                fiscal year 1995; and
                                    ``(II) the per visit payment rate 
                                established under subsection (b) for 
                                such type of home health service for 
                                the fiscal year for which the 
                                determination is being made.
                            ``(ii) Determination of area.--In the case 
                        of an area which the Secretary determines has 
                        an insufficient number of home health agencies 
                        to establish an appropriate per episode limit 
                        under this subparagraph, the Secretary may 
                        establish an area other than the area used to 
                        determine the area wage under section 
                        1886(d)(3)(E) for purposes of establishing an 
                        appropriate per episode limit.
                    ``(C) Case-mix category.--For purposes of this 
                paragraph, the term `case-mix category' means each of 
                the 18 case-mix categories established under the Home 
                Health Agency Prospective Payment Demonstration Project 
                conducted by the Health Care Financing Administration. 
                The Secretary may develop and apply a more accurate 
                methodology for determining case-mix categories subject 
                to prior public notice and comment under section 553 of 
                title 5, United States Code.
                    ``(D) Episode.--
                            ``(i) In general.--For purposes of this 
                        paragraph, the term `episode' means the 
                        continuous 120-day period that--
                                    ``(I) begins on the date of an 
                                individual's first visit for a type of 
                                home health service described in 
                                subsection (a)(2) for a case-mix 
                                category, and
                                    ``(II) is immediately preceded by a 
                                45-day period in which the individual 
                                did not receive visits for a type 
of home health service described in subsection (a)(2).
                            ``(ii) Proration of episode limit spanning 
                        payment years.--The Secretary shall provide for 
                        such rules as appropriate to prorate episode 
                        limits under this paragraph which begin during 
                        a payment year and end in a subsequent payment 
                        year.
                    ``(E) Establishment of a per patient annual limit 
                for services provided after 120 days.--
                            ``(i) In general.--The per patient limit 
                        for services provided by a home health agency 
                        after 120 days for a payment period is equal to 
                        the product of--
                                    ``(I) the sum of 50 percent of the 
                                updated per visit costs described in 
                                paragraph (1)(B)(ii) for the agency and 
                                year and 50 percent of the regional 
                                average described in paragraph 
                                (1)(B)(iii) for the agency and year; 
                                and
                                    ``(II) the average annual number of 
                                medicare home health agency visits over 
                                120 days per unduplicated medicare 
                                beneficiary for fiscal year 1995.
                            ``(ii) New providers and providers without 
                        base year.--The provisions of subparagraph (D) 
                        of paragraph (1) shall apply with respect to 
                        clause (i)(I) in the same manner as they apply 
                        to subparagraph (B)(ii) of paragraph (1).
            ``(3) Exemptions and exceptions.--
                    ``(A) Extraordinary costs.--The Secretary shall 
                provide for an exemption from, or an exception and 
                adjustment to, at the request of the home health 
                agency, the methods under this subsection for 
                determining payment limits where events beyond the home 
                health agency's control or extraordinary circumstances, 
                including the case mix of such home health agency, 
                create reasonable costs for a payment year which exceed 
                the applicable payment limits.
                    ``(B) Other factors.--The Secretary may provide for 
                such other exemptions from, and exceptions and 
                adjustments to, such methods, as the Secretary deems 
                appropriate, as determined by the Secretary.
                    ``(C) Timely determination.--The Secretary shall 
                announce a decision on any request for an exemption, 
                exception, or adjustment under this paragraph not later 
                than 120 days after receiving a completed application 
                from the home health agency for such exemption, 
                exception, or adjustment, and shall include in such 
                decision a detailed explanation of the grounds on which 
                such request was approved or denied.
                    ``(D) Limitation.--The cumulative expenditures for 
                exemptions and exceptions under this paragraph shall 
                not exceed the cumulative amount that would have been 
                payable under paragraph (4)(B) if the 10 percent 
                limitation under clause (ii) of such paragraph did not 
                apply.
            ``(4) Reconciliation of amounts.--
                    ``(A) Payments in excess of limits.--If a home 
                health agency has received aggregate per visit payments 
                under subsection (a) for a fiscal year in excess of the 
                amount determined under paragraph (1) with respect to 
                such home health agency for such fiscal year, the 
                Secretary shall reduce payments under this section to 
                the home health agency in the following fiscal year in 
such manner as the Secretary considers appropriate (including on an 
installment basis) to recapture the amount of such excess.
                    ``(B) Share of savings.--
                            ``(i) Computation.--If a home health agency 
                        has received aggregate per visit payments under 
                        subsection (a) for a payment year in an amount 
                        less than the limit determined under paragraph 
                        (1) or (2) (as applicable) with respect to such 
                        home health agency for such payment year and, 
                        with respect only to paragraphs (1) and (2)(E), 
                        the home health agency has an average payment 
                        per unduplicated medicare beneficiary at or 
                        below 125 percent of the regional average 
                        (described in paragraph (1)(B)(iii) or 
                        (2)(E)(iii), respectively), subject to clause 
                        (ii), the Secretary shall pay such home health 
                        agency a payment equal to 50 percent of the 
                        difference between the aggregate payment and 
                        each applicable limit under paragraphs (1), 
                        (2)(B), or (2)(E).
                            ``(ii) Limitation.--In no case shall 
                        payments under clause (i) for an agency for a 
                        year exceed 10 percent of the aggregate per 
                        visit payments made to the agency for the year.
                            ``(iii) Installment payments.--The 
                        Secretary may make the payments to a home 
                        health agency under clause (i) during a payment 
                        year on an installment basis based on the 
                        estimated payment that the agency would be 
                        eligible to receive with respect to such 
                        payment year.
    ``(d) Medical Review Process.--The Secretary shall implement a 
medical review process for the system of payments described in this 
section that shall provide an assessment of the pattern of care 
furnished to individuals receiving home health services for which 
payments are made under this section to ensure that such individuals 
receive appropriate home health services.
    ``(e) Adjustments.--
            ``(1) In general.--The Secretary shall provide for 
        appropriate adjustments to payments to a home health agency 
        under this section to ensure that the agency does not engage in 
        the following for the purposes of circumventing the limits:
                    ``(A) Discharging patients to another home health 
                agency or similar provider.
                    ``(B) Altering corporate structure or name to avoid 
                being subject to this section or for the purpose of 
                increasing payments under this title.
            ``(2) Tracking of patients that switch home health 
        agencies.--
                    ``(A) Development of system.--The Secretary shall 
                develop a system that tracks home health patients that 
                receive home health services described in subsection 
                (a)(2) from more than 1 home health agency.
                    ``(B) Adjustment of limits.--The Secretary shall 
                adjust limits under this section to each home health 
                agency that furnishes an individual with a type of home 
                health service described in subsection (a)(2) to ensure 
                that aggregate payments on behalf of such individual 
                during such episode do not exceed the amount that would 
                be paid under this section if the individual received 
                such services from a single home health agency.
            ``(3) Monitoring low-cost cases.--
                    ``(A) In general.--The Secretary shall develop and 
                implement a system designed to monitor significant 
                changes in the percentage distribution of low-cost and 
                high-cost patients for which home health services are 
                furnished by a home health agency over such percentage 
                distribution determined for the agency under 
                subparagraph (B).
                    ``(B) Distribution.--The Secretary shall profile 
                home health service patients to determine the 
                distribution of patients for the purpose of determining 
                regional and national trends.
                    ``(C) Low-cost and high-cost patients.--For 
                purposes of this paragraph, the Secretary shall define 
                a low-cost and high-cost patient in a manner that 
                provides that a home health agency has an incentive to 
                be cost efficient in delivering home health services 
                and that the volume of such services does not increase 
                as a result of factors other than patient needs.
                    ``(D) Report on access.--The Secretary shall report 
                to Congress on an annual basis findings and 
                recommendations for ensuring access to appropriate home 
                health services.
    ``(f) Special Rule for Christian Science Providers.--
            ``(1) Payment permitted for services.--Notwithstanding any 
        other provision of this title, payment shall be made under this 
        title for home health services furnished by Christian Science 
        providers who meet applicable requirements of the First Church 
        of Christ, Scientist, Boston, Massachusetts, and are certified 
        for purposes of this title under criteria established by the 
        Secretary, in accordance with a payment methodology established 
        by the Secretary.
            ``(2) Effective date.--Paragraph (1) shall apply to 
        services furnished during cost reporting periods which begin 
        after the date on which the Secretary establishes the payment 
        methodology and the certification criteria described in 
        paragraph (1).
    ``(g) Report by Medicare Prospective Payment Review Commission.--
During the first 3 years in which payments are made under this section, 
the Medicare Prospective Payment Review Commission shall annually 
submit a report to Congress on the effectiveness of the payment 
methodology established under this section that shall include 
recommendations regarding the following:
            ``(1) Case-mix and volume increases.
            ``(2) Quality monitoring of home health agency practices.
            ``(3) Whether providers of service are adequately 
        reimbursed.
            ``(4) On the adequacy of the exemptions and exceptions to 
        the limits provided under subsection (c)(1)(E).
            ``(5) The appropriateness of the methods provided under 
        this section to adjust the aggregate limits and annual payment 
        updates to reflect changes in the mix of services, number of 
        visits, and assignment to case categories to reflect changing 
        patterns of home health care.
            ``(6) The geographic areas used to determine the per 
        episode and per patient limits.
    ``(h) Development of Episodic Prospective Payment System for Home 
Health Services.--
            ``(1) In general.--The Secretary shall develop a method 
        payments for home health services under this title in 
        accordance with an episodic prospective payment system. In 
        developing the system, the Secretary shall take into 
        consideration--
                    ``(A) the data and processes from subsection (c)(2) 
                that have proven valid and reliable, and
                    ``(B) the degree of disruption resulting from 
                changing the payment system.
            ``(2) Additional considerations.--The per episode amount 
        under the system shall include all services covered and paid 
        under home health services under this title as of the date of 
        the enactment of this section, including medical supplies. In 
        defining an episode of care under the system, the Secretary 
        shall consider an appropriate length of time for an episode, 
        the use of services and the number of visits provided within an 
        episode, potential changes in the mix of services provided 
        within an episode and their cost, and a general system design 
        that will provide for continued access to quality services. The 
        per episode amount shall be based on the most current data 
        available to the Secretary and shall include consideration of 
        the cost of new regulatory requirements, changes in technology, 
        and new care practices.
            ``(3) Use of case mix adjuster.--Under the system the 
        Secretary shall employ an appropriate case mix adjuster that 
        explains a significant amount of the variation in cost.
            ``(4) Updates and labor adjustment.--Under the system, the 
        episode payment amount shall be updated annually by the home 
        health market basket index and the labor portion of the episode 
        amount shall be adjusted for geographic differences in labor-
        related costs based on the most current hospital wage index.
            ``(5) Outliers.--Under the system the Secretary may 
        designate a payment provision for outliers, recognizing the 
        need to adjust payments due to unusual variations in the type 
        or amount of medically necessary care.
            ``(6) Coordination requirement.--Under the system, a home 
        health agency shall be responsible for coordinating all care 
        for a beneficiary under this title.
            ``(7) Input.--The system shall be developed with input from 
        and coordination with representatives from the home health 
        services industry and consumers of home health services.
            ``(8) Proposal.--The Secretary shall submit to Congress a 
        proposal for the system, consistent with this subsection, not 
        later than 4 years after the date of the enactment of this 
        section.
            ``(9) Implementation.--The system developed under this 
        subsection shall become effective only pursuant to an Act of 
        Congress. It is the intent of Congress that the effective date 
        of the system be not later than 18 months after the enactment 
        of such an Act.
    ``(i) Development of Data Base.--Within 60 days after the date of 
the enactment of this section, the Secretary shall initiate the 
development of a data base upon which a fair and accurate case mix 
adjustor, as required by subsections (c)(2)(C) and (h)(3), can be 
developed and implemented. The data base must--
            ``(1) be capable of linking case mix data with cost and 
        utilization data;
            ``(2) contain data from HCFA Forms 485 and UB-92;
            ``(3) contain additional data elements sufficient to 
        support the case-mix categories in subsection (c)(2)(C); and
            ``(4) contain any additional data elements determined 
        necessary by the Secretary in consultation with representatives 
        of the home health industry.''.
    (b) Appeals to Provider Reimbursement Review Board.--Section 
1878(a) of such Act (42 U.S.C. 1395oo(a)) is amended by inserting ``, 
any home health agency which has received payment pursuant to section 
1894 may obtain a hearing by the Board, with respect to such payment,'' 
after ``subsection (h)''.
    (c) Sunset of Reasonable Cost Limitations.--Section 1861(v)(1)(L) 
of such Act (42 U.S.C. 1395x(v)(1)(L)) is amended by adding at the end 
the following new clause:
    ``(iv) This subparagraph shall apply only to services furnished by 
home health agencies before the effective date of section 1894.''.
    (d) Effective Date.--The amendments made by subsections (a) and (c) 
shall apply to payment for home health services furnished on or after 
such date (not later than 6 months after the date of the enactment of 
this Act) as the Secretary of Health and Human Services specifies.

SEC. 3. REVIEW BY PEER REVIEW ORGANIZATION OF HOME HEALTH SERVICES.

    (a) In general.--Section 1154 of the Social Security Act (42 U.S.C. 
1320c-3) is amended following new subsections:
    ``(g)(1) Each contract under this part shall require that the 
utilization and quality control peer review organization's review 
responsibility pursuant to subsection (a)(1) will include review of the 
level of care and quality of services provided individuals receiving 
home health services pursuant to sections 1812(a)(3) and 
1832(a)(2)(A)(i).
    ``(2) If--
            ``(A) a home health agency has determined that a patient 
        does not meet the conditions for payment of home health 
        services under section 1814 or section 1833,
            ``(B) the home health agency has determined that a patient 
        no longer requires home health services,
            ``(C) the home health agency has determined that a patient 
        requires a level of care which is inconsistent with the care 
        prescribed by the patient's attending physician, or
            ``(D) the patient has been authorized by the home health 
        agency to receive a level of care less than that considered by 
        the patient as appropriate to meet the patient's needs,
the home health agency shall provide the patient (or the patient's 
representative) with a notice (meeting the conditions prescribed by the 
Secretary under section 1879) of the determination.
    ``(3)(A) If the patient (or patient's representative)--
                    ``(i) has received a notice under paragraph (2), 
                and
                    ``(ii) requests the appropriate peer review 
                organization to review the determination,
        the organization shall conduct a review under subsection (a) of 
        the validity of the home health agency's determination and 
        shall provide notice (by telephone and in writing) to the 
patient or representative and the home health agency and attending 
physician involved of the results of the review. Such review shall be 
conducted regardless of whether the home health agency will charge for 
continued home health services or whether the patient will be liable 
for payment for such continued care.
    ``(B) If a patient (or a patient's representative) requests review 
under subparagraph (A) while the patient is still a patient of the home 
health agency and not later than noon of the first working day after 
the date the patient receives the notice under paragraph (2), then--
            ``(i) the home health agency shall provide to the 
        appropriate peer review organization the records required to 
        review the determination by the close of business of such first 
        working day, and
            ``(ii) the peer review organization must provide the notice 
        under subparagraph (A) by not later than one full working day 
        after the date the organization has received the request and 
        such records.
    ``(4) If--
            ``(A) a request is made under paragraph (3)(A) not later 
        than noon of the first working day after the date that the 
        patient (or patient's representative) receives the notice under 
        paragraph (2), and
            ``(B) the conditions described in section 1879(a)(2) with 
        respect to the patient or representative are met,
the home health agency shall not charge the patient for home health 
services furnished before noon of the day after the date the patient or 
representative receives notice of the peer review organization's 
decision.
    ``(5) In any review conducted under paragraph (2) or (3), the 
organization shall solicit the views of the patient involved (or the 
patient's representative).
    ``(h) The utilization and quality control peer review organization 
shall monitor the delivery of home health services in a manner which 
includes a review of home health agencies that present significant 
variation in utilization.''.
    (b) Hearing Rights.--Section 1155 of such Act (42 U.S.C. 1320c-4) 
is amended by adding at the end the following: ``Notwithstanding the 
previous provisions of this section, any beneficiary receiving home 
health services subject to review under section 1154(g), and the 
provider, who is dissatisfied with a determination, shall be entitled 
to a hearing by the Secretary and to judicial review of any final 
determination to the same extent as provided under section 1869.''.
    (c) Elimination of Certain Fiscal Intermediary Responsibilities.--
Section 1816(j) of such Act (42 U.S.C. 1395h(j)) is amended by striking 
``home health services,''.
    (d) Effective Date.--The amendments made by subsections (a) and (c) 
shall apply to contract years beginning after the date of the enactment 
of this Act.

SEC. 4. RETROACTIVE REINSTATEMENT OF PRESUMPTIVE WAIVER OF LIABILITY.

    (a) In General.--Section 9305(g)(3) of the Omnibus Budget 
Reconciliation Act of 1986, as amended by section 426(d) of the 
Medicare Catastrophic Coverage Act of 1988 and section 4207(b)(3) of 
the Omnibus Budget Reconciliation Act of 1990 (as renumbered by section 
160(d)(4) of the Social Security Act Amendments of 1994), is amended by 
striking ``December 31, 1995'' and inserting ``the date of 
implementation of a prospective payment system for home health care 
services under section 1894(h) of the Social Security Act''.
    (b) Presumption.--The second sentence of section 9205 of the 
Consolidated Omnibus Budget Reconciliation Act of 1985 is amended by 
striking ``December 31, 1995'' and inserting ``the date of 
implementation of a prospective payment system for home health care 
services under section 1894(h) of such Act''.
                                 <all>