[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4727 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4727

   To amend title XVIII of the Social Security Act to delay the 15% 
 reduction and to make revisions in the per beneficiary and per visit 
   payment limits on payment for health services under the Medicare 
                    Program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 7, 1998

Mr. Stark (for himself, Mr. Dingell, Mr. Brown of Ohio, Mr. Matsui, Mr. 
    Coyne, Mr. Levin, Mr. Cardin, Mr. McDermott, and Mr. McGovern) 
 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 delay the 15% 
 reduction and to make revisions in the per beneficiary and per visit 
   payment limits on payment for 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. REVISION OF PER BENEFICIARY LIMITS AND PER VISIT PAYMENT 
              LIMITS FOR PAYMENT FOR HOME HEALTH SERVICES UNDER THE 
              MEDICARE PROGRAM.

    (a) Revision of Per Beneficiary Limits.--
            (1) In general.--Section 1861(v)(1)(L)(v) of the Social 
        Security Act (42 U.S.C. 1395x(v)(1)(L)(v)) is amended to read 
        as follows:
    ``(v)(I) 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--
            ``(aa) the applicable amount under subclause (II) or (III); 
        and
            ``(bb) the agency's unduplicated census count of patients 
        (entitled to benefits under this title) for the cost reporting 
        period subject to the limitation.
    ``(II) The applicable limit for cost reporting periods beginning in 
fiscal year 1998 is an agency-specific per beneficiary annual 
limitation calculated based 75 percent on 98 percent of the reasonable 
costs (including nonroutine medical supplies) for the agency's 12-month 
cost reporting period ending during fiscal year 1994, and based 25 
percent on 98 percent of the standardized regional average of such 
costs for the agency's census division, as applied to such agency, for 
cost reporting periods ending during fiscal year 1994, such costs 
updated by the home health market basket index.
    ``(III) The applicable limit for cost reporting periods beginning 
on or after October 1, 1998, is an agency-specific per beneficiary 
annual limitation calculated--
            ``(aa) based 50 percent on the per beneficiary annual 
        limitation determined under subclause (II) for the agency;
            ``(bb) based 25 percent on the standardized national mean 
        equal to $3,708.25 for fiscal year 1999 (of which $2,880.12 is 
        the labor component, and $828.13 is the non-labor component); 
        and
            ``(cc) based 25 percent on the standardized regional 
        average of the limits for the agency's census division (as 
        specified in Tables 3B and 3D published in the Federal Register 
        on August 11, 1998 (63 FR 42926));
such limits updated by the home health market basket for each 
subsequent fiscal year (if any) through the fiscal year involved.''.
            (2) New agencies.--Section 1861(v)(1)(L)(vi) of the Social 
        Security Act (42 U.S.C. 1395x(v)(1)(L)(vi)) is amended--
                    (A) in subclause (I), by striking ``For new'' and 
                inserting ``Subject to subclause (II), for new'';
                    (B) by redesignating subclause (II) as subclause 
                (III); and
                    (C) by inserting after subclause (I) the following:
            ``(II) In the case of cost reporting periods beginning on 
        or after October 1, 1998, the limits in subclause (I) shall be 
        determined as if any reference in clause (v)(II) to `98 
        percent' were a reference to `100 percent'.
            (3) Conforming amendment.--Section 1861(v)(1)(L)(vii)(I) of 
        the Social Security Act (42 U.S.C. 1395x(v)(1)(L)(vii)(I)) is 
        amended by striking ``clause (v)(I)'' and inserting ``clause 
        (v)(II)''.
    (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, 110 percent of such median.''.
    (c) One-year Delay in Implementation of Mandatory Reduction in 
Payment Limits.--Section 4603(e) of the Balanced Budget Act of 1997 (42 
U.S.C. 1395fff note) is amended--
            (1) by striking ``described in subsection (d)'' and 
        inserting ``beginning on or after October 1, 2000''; and
            (2) by striking ``September 30, 1999'' and inserting 
        ``September 30, 2000''.
    (d) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply to cost reporting periods beginning on or after October 1, 
1998.

SEC. 2. TWO OFFSETS.

    (a) Change in Number of Individuals Eligible To Enroll Under 
Medicare MSA.--Section 1851(b)(4)(A)(ii) of the Social Security Act (42 
U.S.C. 1395w-21(b)(4)(A)(ii)) is amended by striking ``390,000'' and 
inserting ``100,000 (for any date before January 1, 2004) or 500,000 
(for any date thereafter)''.
    (b) Three-Year Extension of Medicare MSA Termination Date.--Section 
1851(b)(4)(A)(i) of the Social Security Act (42 U.S.C. 1395w-
21(b)(4)(A)(i)) is amended by striking ``2003'' and inserting ``2006''.
                                 <all>