[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5163 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5163

    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

                           September 13, 2000

Mr. McGovern (for himself, Mr. Peterson of Pennsylvania, Mr. Hilliard, 
 Mr. Watkins, Mr. Jefferson, Mr. English, Mr. McIntosh, Mrs. Thurman, 
   Mr. Hilleary, Mr. Weygand, Mr. Sanders, Mr. Cook, Mr. Rahall, Mr. 
 Tierney, Mr. Moakley, Mr. Wamp, Mr. Pomeroy, Mr. Conyers, Mr. Goode, 
    Mr. Dickey, Mr. Doyle, Mr. Frank of Massachusetts, Mr. Ney, Ms. 
   Millender-McDonald, Mr. Romero-Barcelo, Mr. Frost, Mr. Kind, Mr. 
     Baldacci, Mr. Olver, Mr. Murtha, Mr. Goodling, and Mr. Allen) 
 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 ``Home Health Refinement Amendments of 
2000''.

SEC. 2. 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. 3. ADDITIONAL PAYMENTS FOR OUTLIERS.

    (a) In General.--Section 1895(b)(5) of the Social Security Act (42 
U.S.C. 1395fff(b)(5)) is amended--
            (1) by striking ``Outliers.--The Secretary'' and inserting 
        the following (and conforming the indentation of the succeeding 
        matter accordingly): ``Outliers.--
                    ``(A) In general.--The Secretary''; and
            (2) by adding at the end the following new subparagraph:
                    ``(B) Temporary additional payments for outliers.--
                For the purposes described in the first sentence of 
                subparagraph (A), there are authorized to be 
                appropriated from the trust funds (as defined in 
                section 1896(a)(8)) in appropriate part, as determined 
                by the Secretary, for each of fiscal years 2001 through 
                2005 an amount equal to $500,000,000. Such amounts 
                shall be in addition to amounts available for payment 
                under this section and shall not result in an reduction 
                of the standard prospective payment amount (or 
                amounts). In making payments under this subparagraph, 
                the Secretary shall use a loss-sharing ratio of 90 
                percent.''.
    (b) Conforming Amendment.--Section 1895(b)(3)(C) of such Act (42 
U.S.C. 1395fff(b)(3)(C)) is amended by striking ``paragraph (5)'' and 
inserting ``paragraph (5)(A)''.

SEC. 4. 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)), 
        notwithstanding any other provision of this subsection, the 
        amount of payment for such services is equal to 110 percent of 
        the payment amount otherwise made under this section (but for 
        this paragraph) for services furnished in a rural area.''.
    (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) Inapplicability of Adjustments for 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 apply with 
respect to items and services furnished on or after October 1, 2000.

SEC. 5. EXCLUSION OF NONROUTINE MEDICAL SUPPLIES UNDER THE PPS FOR HOME 
              HEALTH SERVICES.

    (a) In General.--Section 1895 of the Social Security Act (42 U.S.C. 
1395fff) is amended by adding at the end the following new subsection:
    ``(e) Exclusion of Nonroutine Medical Supplies.--
            ``(1) In general.--Notwithstanding the preceding provisions 
        of this section, in the case of all nonroutine medical supplies 
        (as defined by the Secretary) furnished by a home health agency 
        during a year (beginning with 2001) for which payment is 
        otherwise made on the basis of the prospective payment amount 
        under this section, payment under this section shall instead be 
        based on the lesser of--
                    ``(A) the actual charge for the nonroutine medical 
                supply, or
                    ``(B) the amount determined for such supply under 
                the applicable fee schedule under part B.
            ``(2) Budget neutrality adjustment.--The Secretary shall 
        provide for an appropriate proportional reduction in payments 
        under this section so that beginning with fiscal year 2001, the 
        aggregate amount of such reductions is equal to the aggregate 
        increase in payments (as estimated by the Secretary) 
        attributable to the exclusion effected under paragraph (1).''.
    (b) Conforming Amendments.--(1) Section 1895(b)(1) of the Social 
Security Act (42 U.S.C. 1395fff(b)(1)) is amended by striking ``The 
Secretary'' and inserting ``Subject to subsection (e), the Secretary''.
    (2) Sections 1842(b)(6)(F) and 1862(a)(21) of the Social Security 
Act (42 U.S.C. 1395u(b)(6)(F); 1395y(a)(21)) are each amended by 
striking ``(including medical supplies described in section 1861(m)(5), 
but excluding durable medical equipment to the extent provided for in 
such section)'' and inserting ``(other than medical supplies and 
durable medical equipment described in section 1861(m)(5))''.
    (c) Effective Date.--The amendments made by this section apply with 
respect to items and services furnished on or after October 1, 2000.

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. Each home health agency that 
                submits a cost report to the Secretary under this 
                section shall include, in such cost report, data with 
                respect to the costs incurred in furnishing home health 
                services to medicare beneficiaries via such 
                telecommunications systems.
                    ``(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>