[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1917 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1917

To direct the Secretary of Health and Human Services to make additional 
  payments under the Medicare Program to certain home health agencies 
 with high-cost patients, to provide for an interest-free grace period 
for the repayment of overpayments made by the Secretary to home health 
                   agencies, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 25, 1999

   Mr. McGovern (for himself, Mr. Coburn, Mr. Weygand, Mr. Barton of 
 Texas, Mr. McIntosh, Mr. Rahall, Mr. Hilleary, Ms. Hooley of Oregon, 
 Mr. Wamp, and Mr. Ackerman) 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 direct the Secretary of Health and Human Services to make additional 
  payments under the Medicare Program to certain home health agencies 
 with high-cost patients, to provide for an interest-free grace period 
for the repayment of overpayments made by the Secretary to home health 
                   agencies, 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 ``Home Health Access Preservation Act 
of 1999''.

SEC. 2. ADDITIONAL PAYMENTS TO AGENCIES FOR MOST EXPENSIVE CASES.

    (a) Payments for Outliers.--
            (1) In general.--Subject to paragraph (2), from amounts 
        appropriated pursuant to subsection (e), the Secretary of 
        Health and Human Services shall pay an additional amount to 
        home health agencies furnishing qualified home health services 
        during a cost reporting period beginning on or after October 1, 
        1997, under the medicare program (under title XVIII of the 
        Social Security Act).
            (2) Limitation of payments.--No payment shall be made under 
        this section to a home health agency that, as of the date of 
        the enactment of this Act, has ceased furnishing home health 
        services for which payment may be made under the medicare 
        program (under such title).
    (b) Description of Qualified Services.--For purposes of additional 
payment amounts under this section by the Secretary to home health 
agencies, qualified home health services are home health services 
furnished under the medicare program for the treatment of conditions 
within a diagnosis described in subsection (c).
    (c) Description of Diagnosis.--A diagnosis described in this 
subsection is one of the following diagnoses as classified in St. 
Anthony's ICD-9-CM Code Book for Physician Payment:
            (1) diabetes mellitus (ICD-9-CM code 250).
            (2) essential hypertension (ICD-9-CM code 401).
            (3) other forms of chronic ischemic heart disease (ICD-9-CM 
        code 414).
            (4) heart failure (ICD-9-CM code 428).
            (5) acute, but ill-defined cerebrovascular disease (ICD-9-
        CM code 436).
            (6) pneumonia, organism unspecified (ICD-9-CM code 486).
            (7) chronic airway obstruction, not elsewhere classified 
        (ICD-9-CM code 496).
            (8) chronic ulcer of skin (ICD-9-CM code 707).
            (9) symptoms involving urinary system (ICD-9-CM code 788).
            (10) fracture of neck of femur (ICD-9-CM code 820).
    (d) Determination of Agency-Specific Payment Amount.--
            (1) Certification of quantity of qualified home health 
        services furnished.--
                    (A) In general.--With respect to a fiscal year, a 
                home health agency may submit to the Secretary a 
                certification of the number of patients to whom the 
                agency furnished qualified home health services during 
                the agency's cost reporting period beginning in that 
                fiscal year.
                    (B) Deadline for submission.--
                            (i) In general.--Such certification shall 
                        be submitted to the Secretary during the 30-day 
                        period beginning on the date the agency submits 
                        to the Secretary a cost report for the cost 
                        reporting period beginning in such fiscal year.
                            (ii) Transition rule.--In the case of an 
                        agency with a cost reporting period beginning 
                        on or after October 1, 1997, that ends before 
                        the date of the enactment of this Act, with 
                        respect to such cost reporting period, the 30-
                        day period under clause (i) begins 60 days 
                        after the date of the enactment of this Act.
            (2) Determination of aggregate qualified home health 
        services furnished.--From data contained in certifications 
submitted under paragraph (1) with respect to cost reporting periods 
beginning in fiscal years 1998, 1999, and 2000, the Secretary shall 
determine, with respect to a fiscal year, the number of patients who 
have received qualified home health services furnished by agencies 
submitting such certifications for that fiscal year. The Secretary 
shall make such determination by not later than 120 days after all cost 
reports for that fiscal year have been received.
            (3) Agency-specific percentage of aggregate amount.--For 
        each home health agency submitting a certification under 
        paragraph (1) for a fiscal year described in paragraph (2), the 
        Secretary shall determine an agency-specific percentage by 
        dividing the number of patients certified by the home health 
        agency for that fiscal year by the national total specified in 
        paragraph (2) for that fiscal year.
            (4) Payment amount.--The Secretary shall pay for a fiscal 
        year described in paragraph (2) to a home health agency making 
        the certification under paragraph (1) an amount equal to the 
        product of the percentage determined under paragraph (3) and 
        the amount appropriated for such fiscal year under subsection 
        (e).
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated from the Federal Hospital Insurance Trust Fund 
(established under section 1817 of the Social Security Act (42 U.S.C. 
1395i)) for making additional payments to home health agencies under 
this section, $250,000,000 in each of the fiscal years 2000 through 
2002.
    (f) Termination.--The Secretary shall not make additional payments 
under this section for cost reporting periods, or portions of cost 
reporting periods, beginning on or after the date of the implementation 
of the prospective payment system for home health services under 
section 1895 of the Social Security Act (42 U.S.C. 1395fff).
    (g) Limitation on Judicial Review.--There shall be no 
administrative or judicial review under section 1869 of the Social 
Security Act (42 U.S.C. 1395ff), section 1878 of such Act (42 U.S.C. 
1395oo), or otherwise of any action of the Secretary with respect to 
the determination of an additional payment amount under this section.

SEC. 3. OVERPAYMENTS.

    (a) 36-Month Repayment Period.--In the case of an overpayment by 
the Secretary of Health and Human Services to a home health agency for 
home health services furnished during a cost reporting period beginning 
on or after October 1, 1997, as a result of payment limitations 
provided for under clause (v), (vi), or (viii) of section 1861(v)(1)(L) 
of the Social Security Act (42 U.S.C. 1395x(v)(1)(L)), the home health 
agency may elect to repay the amount of such overpayment over a 36-
month period beginning on the date of notification of such overpayment.
    (b) Interest on Overpayment Amounts.--
            (1) 36-month grace period.--
                    (A) In general.--In the case of an agency that 
                makes an election under subsection (a), no interest 
                shall accrue on the outstanding balance of the amount 
                of overpayment during such 36-month period.
                    (B) Overdue balances.--In the case of such an 
                agency, interest shall accrue on any outstanding 
                balance of the amount of overpayment after termination 
                of such 36-month period. Interest shall accrue under 
                this subparagraph at the rate of interest charged by 
                banks for loans to their most favored commercial 
                customers, as published in the Wall Street Journal on 
                the Friday immediately following the date of the 
                enactment of this Act.
            (2) Other agencies.--In the case of an agency described in 
        subsection (a) that does not make an election under subsection 
        (a), interest shall accrue on the outstanding balance of the 
        amount of overpayment at the rate described in the second 
        sentence of paragraph (1)(B).
    (c) Termination.--No election under subsection (a) may be made for 
cost reporting periods, or portions of cost reporting periods, 
beginning on or after the date of the implementation of the prospective 
payment system for home health services under section 1895 of the 
Social Security Act (42 U.S.C. 1395fff).
    (d) Effective Date.--The provisions of subsection (a) shall take 
effect as if included in the enactment of the Balanced Budget Act of 
1997.

SEC. 4. UPDATE ON IMPLEMENTATION OF PROSPECTIVE PAYMENT SYSTEM FOR HOME 
              HEALTH AGENCIES.

    Not later than 90 days after the date of enactment of this Act, and 
every 90 days thereafter until the prospective payment system for home 
health agencies (established by section 1895 of the Social Security Act 
(42 U.S.C. 1395fff)) is implemented, the Secretary of Health and Human 
Services shall meet with the staff of the appropriate committees of 
Congress to provide an informal update regarding the progress of the 
Secretary in implementing such payment system.
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