[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4567 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4567

 To amend title XVIII of the Social Security Act to make revisions in 
the per beneficiary and per visit payment limits on payment for health 
                  services under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 15, 1998

  Mr. Thomas (for himself and Mr. McGovern) introduced the following 
  bill; which was referred to the Committee on Way 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 make revisions in 
the per beneficiary and per visit payment limits on payment for health 
                  services 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.

    This Act may be cited as the ``Medicare Home Health Care Interim 
Payment System Refinement Act of 1998''.

SEC. 2. INCREASE IN PER BENEFICIARY LIMITS AND PER VISIT PAYMENT LIMITS 
              FOR PAYMENT FOR HOME HEALTH SERVICES UNDER THE MEDICARE 
              PROGRAM.

    (a) Increase in Per Beneficiary Limits.--
            (1) In general.--Section 1861(v)(1)(L) of the Social 
        Security Act (42 U.S.C. 1395x(v)(1)(L)) is amended--
                    (A) in the first sentence of clause (v), by 
                inserting ``subject to clause (viii)(I),'' before ``the 
                Secretary'';
                    (B) in clause (vi)(I), by inserting ``subject to 
                clause (viii)(II)'' after ``fiscal year 1994''; and
                    (C) by adding at the end the following new clause:
    ``(viii)(I) In no case shall the limit imposed under clause (v) for 
cost reporting periods beginning during fiscal year 1999 be less than 
the average of the limit otherwise imposed under such clause and the 
median described in clause (vi)(I) (but determined as if any reference 
in clause (v) to `98 percent' were a reference to `100 percent').
    ``(II) Subject to subclause (III), for cost reporting periods 
beginning during or after fiscal year 1999, in no case shall the limit 
imposed under clause (vi)(I) be less than the median described in such 
clause (determined as if any reference in clause (v) to `98 percent' 
were a reference to `100 percent'.
    ``(III) In the case of new home health agency for which the first 
cost reporting period begins during or after fiscal year 1999, with 
respect to such cost reporting period the limitation applied under 
clause (vi)(I) (but only with respect to such provider) shall be equal 
to 75 percent of the median described in subclause (II) of this clause.
    ``(IV) The limits computed under subclauses (I) through (III) are 
subject to adjustment under clause (iii) to reflect variations in wages 
among different areas.''.
            (2) Exclusion of additional part b costs from determination 
        of part b monthly premium.--Section 1839 of the Social Security 
        Act (42 U.S.C. 1395r) is amended--
                    (A) in subsection (a)(3), by striking ``in 
                subsection (e)'' and inserting ``in subsections (e) and 
                (g)'', and
                    (B) by adding at the end the following new 
                subsection:
    ``(g) In estimating the benefits and administrative costs which 
will be payable from the Federal Supplementary Medical Insurance Trust 
Fund for a year for purposes of determining the monthly premium rate 
under subsection (a)(3), the Secretary shall exclude an estimate of any 
benefits and administrative costs attributable to the application of 
section 1861(v)(1)(L)(viii), but only to the extent payment for home 
health services under this title is not being made under section 1895 
(relating to prospective payment for home health services).''.
    (b) Revision of Per Visit Limits.--Section 1861(v)(1)(L)(i) of such 
Act (42 U.S.C. 1395x(v)(1)(L)(i)) is amended--
            (1) in subclause (III), by striking ``or'';
            (2) in subclause (IV)--
                    (A) by inserting ``and before October 1, 1998,'' 
                after ``October 1, 1997,''; and
                    (B) by striking the period at the end and inserting 
                ``, or''; and
            (3) by adding at the end the following new subclause:
            ``(V) October 1, 1998, 108 percent of such median.''.
    (c) Reports on Summary of Research Conducted by the Secretary on 
the System.--By not later than January 1, 1999, the Secretary of Health 
and Human Services shall submit to Congress a report on the following 
matters:
            (1) Research.--A description of any research paid for by 
        the Secretary on the development of a prospective payment 
        system for home health services furnished under the Medicare 
        care program under title XVIII of the Social Security Act, and 
        a summary of the results of such research.
            (2) Schedule for implementation of system.--The Secretary's 
        schedule for the implementation of the prospective payment 
        system for home health services under section 1895 of the 
        Social Security Act (42 U.S.C. 1395fff).
            (3) Alternative to 15 percent reduction in limits.--The 
        Secretary's recommendations for one or more alternative means 
        to provide for savings equivalent to the savings estimated to 
        be made by the mandatory 15 percent reduction in payment limits 
        for such home health services for fiscal year 2000 under 
        section 1895(b)(3)(A) of the Social Security Act (42 U.S.C. 
        1395fff(b)(3)(A)), or, in the case the Secretary does not 
        establish and implement such prospective payment system, under 
        section 4603(e) of the Balanced Budget Act of 1997. The 
        Secretary shall include a statement from the Chief Actuary of 
        the Health Care Financing Administration of the amount of a per 
        visit copayment that would be required to provide for such 
        savings (based upon different caps on the aggregate amount of 
        such copayments for any person for a year).
    (c) MedPAC Reports.--
            (1) Review of secretary's report.--Not later than 60 days 
        after the date the Secretary of Health and Human Services 
        submits to Congress the report under subsection (b), the 
        Medicare Payment Advisory Commission (established under section 
        1805 of the Social Security Act (42 U.S.C. 1395b-6)) shall 
        submit to Congress a report describing the Commission's 
        analysis of the Secretary's report, and shall include the 
        Commission's recommendations with respect to the matters 
        contained in such report.
            (2) Annual report.--The Commission shall include in its 
        annual report to Congress for June 1999 an analysis of whether 
        changes in law made by the Balanced Budget Act of 1997, as 
        modified by the amendments made by this section, and this 
        section with respect to payments for home health services 
        furnished under the Medicare program under title XVIII of the 
        Social Security Act impede access to such services by 
        individuals entitled to benefits under such program.
    (d) GAO Audit of Research Expenditures.--The Comptroller General of 
the United States shall conduct an audit of sums obligated or expended 
by the Health Care Financing Administration for the research described 
in subsection (b)(1), and of the data, reports, proposals, or other 
information provided by such research.
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