[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4727 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4727

    To amend title XVIII of the Social Security Act with respect to 
  payments made under the prospective payment system for home health 
             services furnished under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 22, 2000

Mr. McGovern (for himself, Mr. Hilleary, Mr. Weygand, and Mr. Peterson 
 of Pennsylvania) 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 with respect to 
  payments made under the prospective payment system for home health 
             services furnished 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 ``Equal Access to Medicare Home Health 
Care Act of 2000''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Over 30,000,000 beneficiaries under the medicare 
        program under title XVIII of the Social Security Act rely on 
        providers of home health services to provide them with cost-
        effective, high quality home health care.
            (2) The medicare home health benefit enables many medicare 
        beneficiaries to remain at home and to live with dignity and 
        independence despite serious health conditions.
            (3) The medicare home health benefit helps alleviate the 
        burden of medicare beneficiaries on hospitals and skilled 
        nursing facilities, where services provided to medicare 
        beneficiaries are more expensive.
            (4) The amendments made by the Balanced Budget Act of 1997 
        to title XVIII of the Social Security Act were originally 
        projected to cut $16,100,000,000 from the medicare home health 
        benefit between fiscal years 1998 and 2002.
            (5) The Congressional Budget Office recently projected that 
        those amendments made by the Balanced Budget Act of 1997 will 
        actually cut $69,400,000,000 from the medicare home health 
        benefit between fiscal years 1998 and 2002.
            (6) The recent projections by the Congressional Budget 
        Office represent more than 4 times the amount of the reduction 
        in the medicare home health benefit originally projected to 
        take effect as a result of the amendments made by the Balanced 
        Budget Act of 1997.
            (7) The failure of the Health Care Financing Administration 
        to disburse payments under the interim payment system 
        established by the Balanced Budget Act of 1997 under section 
        1861(v)(1)(L) of the Social Security Act in a timely manner has 
        resulted in medicare overpayments to thousands of providers of 
        home health services, leaving many of these providers on 
        precarious financial footing.
            (8) Access to care, particularly for high-cost and long-
        term patients, has become a growing problem because the amount 
        of payment for these types of patients under the current 
        interim payment system is insufficient.
            (9) Under the proposed regulation implementing the new 
        prospective payment system, 50 percent of the prospective 
        payment amount will be paid upon receipt and processing of the 
        providers initial claim for reimbursement and 50 percent of 
        that amount will be delayed until the final claim is processed 
        at the end of the 60-day episode period.
            (10) Medicare beneficiaries incur most home health care 
        expenses during the first 30 days of a 60-day episode period 
        and providers of home health services do not have large cash 
        reserves to support delayed payment for those services under 
        the medicare program.
            (11) It is essential that the Administrator of the Health 
        Care Financing Administration ensure that the initial payment 
        to providers of home health services during a 60-day episode 
        period of home health care provided under the medicare home 
        health benefit provides a steady cash flow for those providers 
        so that medicare beneficiaries may continue to receive 
        necessary home health services.
            (12) Studies by the Medicare Payment Advisory Commission 
        established under section 1805 of the Social Security Act have 
        indicated that certain populations of medicare beneficiaries 
        risk not receiving necessary home health services because of 
        the systemic changes made by the Balanced Budget Act of 1997.
            (13) Because the aggregate amount of payment made for all 
        home health services during the first year in which payment 
        will be made for those services under the prospective payment 
        system is limited to the amount that would have been paid in 
        such year for those services under the interim payment system, 
        there is an enormous risk that this limited amount will be 
        insufficient, resulting in a perpetuation of the current crisis 
        under the interim payment system for home health services.

SEC. 3. ELIMINATION OF 15 PERCENT REDUCTION IN PAYMENT RATES UNDER THE 
              MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR HOME HEALTH 
              SERVICES.

    (a) In General.--Section 1895(b)(3)(A) of the Social Security Act 
(42 U.S.C. 1395fff(b)(3)(A)), as amended by sections 302(b) and 303(f) 
of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 
1999 (113 Stat. 1501A-359, 361), as enacted into law by section 
1000(a)(6) of Public Law 106-113, is amended to read as follows:
                    ``(A) Initial basis.--Under such system the 
                Secretary shall provide for computation of a standard 
                prospective payment amount (or amounts). Such amount 
                (or amounts) shall initially be based on the most 
                current audited cost report data available to the 
                Secretary and shall be computed in a manner so that the 
total amounts payable under the system for the 12-month period 
beginning on the date the Secretary implements the system shall be 
equal to the total amount that would have been made if the system had 
not been in effect and if section 1861(v)(1)(L)(ix) had not been 
enacted. Each such amount shall be standardized in a manner that 
eliminates the effect of variations in relative case mix and area wage 
adjustments among different home health agencies in a budget neutral 
manner consistent with the case mix and wage level adjustments provided 
under paragraph (4)(A). Under the system, the Secretary may recognize 
regional differences or differences based upon whether or not the 
services or agency are in an urbanized area.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the enactment of the Medicare, Medicaid, 
and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106-113).

SEC. 4. 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)), with respect to 
the repayment by the home health agency of such overpayment, interest 
shall accrue on the outstanding balance of that overpayment as provided 
in subsection (b).
    (b) Interest on Overpayment Amounts.--
            (1) 36-month grace period.--No interest shall accrue on the 
        outstanding balance of the amount of overpayment during the 36-
        month period beginning on the date of notification of the 
        overpayment.
            (2) Overdue balances.--Interest shall accrue on any 
        outstanding balance of the amount of overpayment after the 
        termination of such 36-month period. Interest shall accrue 
        under this paragraph 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.
    (c) Termination.--The provisions of this section shall not apply to 
an overpayment made by the Secretary of Health and Human Services to a 
home health agency 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. 5. ADDITIONAL PAYMENTS UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR 
              SERVICES FURNISHED IN RURAL AREAS AND SECURITY SERVICES.

    (a) Increase in Payment Rates for Rural Agencies.--Section 1895(b) 
of the Social Security Act (42 U.S.C. 1395fff(b)) is amended by adding 
at the end the following new paragraph:
            ``(7) Additional payment amount for services furnished in 
        rural areas.--In the case of home health services furnished in 
        a rural area (as defined in section 1886(d)(2)(D)), the 
        Secretary shall provide for an addition or adjustment to the 
        payment amount otherwise made under this section for services 
        furnished in a rural area in an amount equal to 10 percent of 
        the amount otherwise determined under this subsection.''.
    (b) Additional Payment for Security Services.--Section 1895(b) of 
such Act (42 U.S.C. 1395fff(b)(3)), as amended by subsection (a), is 
further amended by adding at the end the following paragraph:
            ``(8) Additional payment for security services.--The 
        Secretary shall provide for an addition or adjustment to the 
        payment amount otherwise made under this section for the 
        reasonable cost (as defined in section 1861(v)(1)(A)) of 
        furnishing protective services to individuals furnishing home 
        health services under this title in areas where such 
        individuals are at risk of physical harm, as determined by the 
        Secretary.''.
    (c) Waiving Budget Neutrality.--Section 1895(b)(3) of such Act (42 
U.S.C. 1395fff(b)(3)) is amended by adding at the end the following new 
subparagraph:
                    ``(D) No adjustment for additional payments for 
                rural services and security services.--The Secretary 
                shall not reduce the standard prospective payment 
                amount (or amounts) under this paragraph applicable to 
                home health services furnished during a period to 
                offset the increase in payments resulting from the 
                application of paragraph (7) (relating to services 
                furnished in rural areas) and paragraph (8) (relating 
                to costs of security services).''.
    (d) Effective Date.--The amendments made by this section shall take 
effect on the date that is 270 days after the date of the enactment of 
this Act.

SEC. 6. RULE OF CONSTRUCTION RELATING TO TELEHOMEHEALTH SERVICES.

    (a) In General.--Section 1895(b) of such Act (42 U.S.C. 
1395fff(b)(3)), as amended by section 3, is further amended by adding 
at the end the following paragraph:
            ``(9) Rule of construction relating to telehomehealth 
        services.--
                    ``(A) In general.--Nothing in this section, or in 
                section 4206(a) of the Balanced Budget Act of 1997 (42 
                U.S.C. 1395l note), shall be construed as preventing a 
                home health agency receiving payment under this section 
                from furnishing a home health service via a 
                telecommunications system.
                    ``(B) Limitation.--The Secretary shall not consider 
                a home health service provided in the manner described 
                in subparagraph (A) to be a home health visit for 
                purposes of--
                            ``(i) determining the amount of payment to 
                        be made under this section; or
                            ``(ii) any requirement relating to the 
                        certification of a physician required under 
                        section 1814(a)(2)(C).''.
    (b) Report.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report containing the recommendations of the 
Secretary with respect to the feasibility and advisability of including 
home health services furnished by telecommunications systems as a home 
health service for purposes of--
            (1) payment for such services under section 1895 of the 
        Social Security Act (42 U.S.C. 1395fff), and
            (2) requirements with respect to physician certification of 
        the need for home health services under section 1814(a)(2)(C) 
        of such Act (42 U.S.C. 1395f(a)(2)(C)).
                                 <all>