[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4252 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4252

 To amend title XVIII of the Social Security Act to revise the interim 
       payment system for home health care furnished to Medicare 
                             beneficiaries.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 16, 1998

Mr. English of Pennsylvania (for himself and Mr. Neal of Massachusetts) 
 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 revise the interim 
       payment system for home health care furnished to Medicare 
                             beneficiaries.

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

SECTION 1. MODIFICATIONS TO INTERIM PAYMENT SYSTEM FOR HOME HEALTH 
              SERVICES UNDER MEDICARE.

    (a) Per Visit Cost Limits.--
            (1) Basis for limits.--Section 1861(v)(1)(L)(i) of the 
        Social Security Act (42 U.S.C. 1395x(v)(1)(L)(i)) is amended--
                    (A) by inserting ``or'' at the end of subclause 
                (II);
                    (B) in subclause (III)--
                            (i) by striking ``and before October 1, 
                        1997''; and
                            (ii) by striking ``, or'' and inserting a 
                        period; and
                    (C) by striking subclause (IV).
            (2) Elimination of out-year effect of 2-year freeze.--
        Section 1861(v)(1)(L) (42 U.S.C. 1395x(v)(1)(L)) is amended--
                    (A) by striking clause (iv) and redesignating 
                clauses (v) and (vi) as clauses (iv) and (v), 
                respectively; and
                    (B) in clause (vii), by striking ``clause (v)(I)'' 
                and inserting ``clause (iv)(I)''.
    (b) Per Beneficiary Cost Limits.--Section 1861(v)(1)(L) of such Act 
(42 U.S.C. 1395x(v)(1)(L)) is amended--
            (1) by amending subclause (I) of clause (iv) (as 
        redesignated by subsection (a)(2)(A)) to read as follows:
            ``(I) a per beneficiary annual limitation calculated based 
        50 percent on the standardized average of reasonable costs 
        (including nonroutine medical supplies) for agencies in the 
        State in which an agency is located for cost reporting periods 
        ending during fiscal year 1994, updated by the home health 
        market basket index, and 50 percent on the standardized 
        national average of reasonable costs (including nonroutine 
        medical supplies) for all agencies for cost reporting periods 
        ending during fiscal year 1994, updated by the home health 
        market basket index; and''; and
            (2) in clause (v) (as redesignated by subsection 
        (a)(2)(A)), by striking ``the following rules'' and all that 
        follows and inserting in lieu thereof ``the per beneficiary 
        limitation established under clause (iv) shall, for 
        beneficiaries who use services furnished by more than one home 
        health agency, be prorated among such agencies.''.
    (c) Efficiency Standard.--Section 1861(v)(1)(L) of such Act (42 
U.S.C. 1395x(v)(1)(L)) is amended--
            (1) in clause (iv) (as redesignated by subsection 
        (a)(2)(A)), by striking ``Payment'' and inserting in lieu 
        thereof ``Except as provided in clause (vi), payment''; and
            (2) by inserting after clause (v) (as redesignated by 
        subsection (a)(2)(A)) the following new clause:
    ``(vi)(I) Notwithstanding clause (iv), for any cost reporting 
period beginning on or after October 1, 1997, for which a home health 
agency's reasonable costs per beneficiary (as limited by clause (i)) do 
not exceed the wage-adjusted national average per beneficiary amount 
described in subclause (II), payment to such agency shall equal the 
agency's reasonable costs determined under clause (i).
    ``(II) For purposes of subclause (I), the `wage-adjusted national 
average per beneficiary amount' for a home health agency for a cost 
reporting period is the national average per beneficiary reasonable 
costs for all home health agencies for cost reporting periods beginning 
in fiscal year 1994 (as determined by the Secretary), updated by the 
home health market basket and adjusted for the wage-related portion of 
such costs by the wage index described in clause (iii).''.
    (d) Contingent Application of Existing Limits.--Section 4603(e) of 
the Balanced Budget Act of 1997 is amended by striking ``a reduction by 
15 percent in'' and inserting ``the application of''.
    (e) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of the Balanced Budget Act of 
1997.
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