[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3567 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 3567

    To amend title XVIII of the Social Security Act to provide for 
 equitable payments to home health agencies under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 26, 1998

 Mr. Pappas (for himself, Mr. Smith of New Jersey, Mr. Saxton, and Mr. 
    Coyne) 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 
 equitable payments to home health agencies under the Medicare Program.

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

SECTION 1. SHORT TITLE.

    The Act may be cited as the ``Medicare Home Health Equity Act of 
1998''.

SEC. 2. PAYMENTS TO HOME HEALTH AGENCIES UNDER MEDICARE.

    (a) Restoration of Per Visit Cost Limit to 112 Percent of the Mean 
of Costs.--Section 1861(v)(1)(L)(i) of the Social Security Act (42 
U.S.C. 1395x(v)(1)(L)(i)), as amended by section 4602(a) of the 
Balanced Budget Act of 1997, is amended--
            (1) in subclause (II), by adding at the end ``or'';
            (2) in subclause (III), by striking ``and before October 1, 
        1997,'' and ``or''; and
            (3) by striking subclause (IV).
    (b) Revision of Interim Payment System for Home Health Services.--
            (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 striking clauses (v) and (vi);
                    (B) by redesignating clause (vii) as clause (viii); 
                and
                    (C) by inserting after clause (iv) the following 
                new clauses:
    ``(v) For services furnished by home health agencies for cost 
reporting periods beginning on or after October 1, 1997, 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) an agency-specific per beneficiary annual limitation 
        calculated based 75 percent on the reasonable costs (including 
        nonroutine medical supplies) of the standardized national 
        average cost per patient in fiscal year 1994 and 25 percent on 
        the reasonable costs (including nonroutine medical supplies) of 
        the standardized regional average cost per patient for the 
        agency's census division in fiscal year 1995, such national and 
        regional costs adjusted as appropriate under clause (vi) and 
        updated by the home health market basket index; 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.
    ``(vi)(I) The Secretary shall adjust the labor-related portion of 
costs determined under clause (v)(I) 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 a cost reporting period beginning after October 1, 1995).
    ``(II) The Secretary shall provide for an addition or adjustment to 
the payment amount otherwise made under this subparagraph in the case 
of outliers because of unusual variations in the type or amount of 
medically necessary care. The total amount of the additional payments 
or payment adjustments made under this subclause with respect to a 
fiscal year may not exceed the total payments otherwise to be made 
under this subparagraph in that year.
    ``(vii) For beneficiaries who use services furnished by more than 
one home health agency, the per beneficiary limitations shall be 
prorated among the agencies.''.
            (2) Conforming Amendment.--Section 1861(v)(1)(L)(viii)) of 
        such Act (42 U.S.C. 1395x(v)(1)(L)(viii)), as so redesignated 
        in paragraph (1)(B), is amended by striking ``April 1, 1998'' 
        and inserting ``May 1, 1998''.
    (c) Effective Date.--The amendments made by this section shall 
apply as if included in the enactment of the Balanced Budget Act of 
1997.
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