II 109th CONGRESS 1st Session S. 1733 IN THE SENATE OF THE UNITED STATES September 20, 2005 Mr. Thune introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To establish pilot projects under the medicare program to provide incentives for home health agencies to utilize home monitoring and communications technologies.
1.
Remote monitoring pilot projects
(a)
Pilot projects
(1)
In general
Not later than 9 months after the date of enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the Secretary) shall conduct pilot projects under title XVIII of the Social Security Act for the purpose of providing incentives to home health agencies to utilize home monitoring and communications technologies that— (A)enhance health outcomes for medicare beneficiaries; and (B)reduce expenditures under such title. (2)
Site requirements
(A)
Urban and Rural
The Secretary shall conduct the pilot projects under this section in both urban and rural areas. (B)
Site in a small state
The Secretary shall conduct at least 1 of the pilot projects in a State with a population of less than 1,000,000. (3)
Definition of home health agency
In this section, the term home health agency has the meaning given that term in section 1861(o) of the Social Security Act (42 U.S.C. 1395x(o)). (b)
Medicare beneficiaries within the scope of projects
The Secretary shall specify the criteria for identifying those medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection (c) and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section. Such criteria may provide for the inclusion in the projects of medicare beneficiaries who begin receiving home health services under title XVIII of the Social Security Act after the date of the implementation of the projects. (c)
Incentives
(1)
Performance targets
The Secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies, as determined appropriate by the Secretary: (A)
Adjusted historical performance target
The Secretary shall establish for the agency— (i)a base expenditure amount equal to the average total payments made to the agency under parts A and B of title XVIII of the Social Security Act for medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the Secretary; and (ii)an annual per capita expenditure target for such beneficiaries, reflecting the base expenditure amount adjusted for risk and adjusted growth rates. (B)
Comparative performance target
The Secretary shall establish for the agency a comparative performance target equal to the average total payments under such parts A and B during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project. (2)
Incentive
Subject to paragraph (3), the Secretary shall pay to each participating home care agency an incentive payment for each year under the pilot project equal to a portion of the medicare savings realized for such year relative to the performance target under paragraph (1). (3)
Limitation on expenditures
The Secretary shall limit incentive payments under this section in order to ensure that the aggregate expenditures under title XVIII of the Social Security Act (including incentive payments under this subsection) do not exceed the amount that the Secretary estimates would have been expended if the pilot projects under this section had not been implemented. (d)
Waiver authority
The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act as the Secretary determines to be appropriate for the conduct of the pilot projects under this section. (e)
Report to Congress
Not later than 5 years after the date that the first pilot project under this section is implemented, the Secretary shall submit to Congress a report on the pilot projects. Such report shall contain a detailed description of issues related to the expansion of the projects under subsection (f) and recommendations for such legislation and administrative actions as the Secretary considers appropriate. (f)
Expansion
If the Secretary determines that any of the pilot projects under this section enhance health outcomes for medicare beneficiaries and reduce expenditures under title XVIII of the Social Security Act, the Secretary may initiate comparable projects in additional areas. (g)
Incentive payments have no effect on other medicare payments to agencies
An incentive payment under this section— (1)shall be in addition to the payments that a home health agency would otherwise receive under title XVIII of the Social Security Act for the provision of home health services; and (2)shall have no effect on the amount of such payments.