[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3865 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 3865

  To amend title XVIII of the Social Security Act to protect Medicare 
   beneficiaries' access to home health services under the Medicare 
                                Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 17, 2007

 Mr. McGovern (for himself and Mr. Jones of North Carolina) introduced 
  the following bill; which was referred to the Committee on Ways and 
 Means, and in addition to the Committee on Energy and 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 protect Medicare 
   beneficiaries' access to home health services 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 Care Access Protection 
Act of 2007''.

SEC. 2. PROTECTING ACCESS TO MEDICARE HOME HEALTH SERVICES.

    (a) In General.--Section 1895(b)(3) of the Social Security Act (42 
U.S.C. 1395fff(b)(3)) is amended--
            (1) in subparagraph (B)(iv), by adding at the end the 
        following: ``Such adjustment shall not be made with respect to 
        home health services for payment in 2008 and in making such an 
        adjustment with respect to home health services for payment in 
        a subsequent year, the Secretary shall evaluate changes in case 
        mix using standards developed by the Secretary consistent with 
        the processes described in subparagraph (D)(i) and taking into 
        account the criteria described in subparagraph (D)(ii).''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Processes and criteria for evaluating changes 
                in case mix.--For purposes of subparagraph (B)(iv)--
                            ``(i) Processes.--The processes described 
                        in this clause are the following:
                                    ``(I) In developing standards 
                                referred to in such subparagraph, the 
                                Secretary shall convene a Technical 
                                Advisory Group consisting of 
                                stakeholders, including individuals and 
                                organizations representing the 
                                interests of Medicare beneficiaries, 
                                the National Association for Home Care 
                                & Hospice, and the Visiting Nurse 
                                Associations of America, health care 
                                academia, and health care 
                                professionals, in equal numbers from 
                                each and limited to parties without an 
                                existing contractual relationship with 
                                the Secretary, to advise the Secretary 
                                concerning the establishment of such 
                                standards in order to distinguish 
                                between real changes in case mix and 
                                changes in coding or classification of 
                                different units of services that do not 
                                reflect real changes in case mix. The 
                                Technical Advisory Group shall be given 
                                the opportunity to review and comment 
                                on any proposed rulemaking or final 
                                determination by the Secretary on such 
                                standards prior to such rulemaking or 
                                determination.
                                    ``(II) If the Secretary engages an 
                                outside contractor to participate in 
                                the evaluation of case mix changes 
                                described in subclause (I), the 
                                Secretary shall only utilize a 
                                contractor that has not previously 
                                participated in the design and 
                                establishment of the case mix 
                                adjustment factors under subparagraph 
                                (B).
                                    ``(III) If the Secretary determines 
                                that any increase in case mix relates 
                                to changes in the volume or nature of 
                                services provided to home health 
                                services patients, the Secretary shall 
                                evaluate that increase through actual 
                                review of claims and services and shall 
                                not use any proxy or surrogate for 
                                determining whether the change in 
                                volume or nature of services is 
                                reasonable and necessary.
                                    ``(IV) The Secretary shall 
                                establish the standards referred to in 
                                subclause (I) by regulation.
                                    ``(V) With respect to establishment 
                                of such standards, the Secretary shall 
                                make public all data, reports, and 
                                supporting materials, including any 
                                comments by the Technical Advisory 
                                Group pursuant to subclause (I), 
                                regarding the standards at the time of 
                                notice of such standards.
                            ``(ii) Criteria.--The criteria described in 
                        this clause are the following:
                                    ``(I) The impact of changes in the 
                                program under this title that may 
                                affect the characteristics of 
                                individuals receiving home health 
                                services.
                                    ``(II) The impact of changes in the 
                                provision of health care services by 
                                providers of services other than home 
                                health agencies.
                                    ``(III) Distinctions in the 
                                characteristics of individuals 
                                initiating home health services from 
                                the community and institutional care 
                                settings.
                                    ``(IV) Whether any changes in 
                                coding resulted in a change in 
                                expenditures overall annually and 
                                disregarding changes in coding that do 
                                not have an overall expenditure impact.
                                    ``(V) Any other factors determined 
                                appropriate by the Secretary in 
                                consultation with the Technical 
                                Advisory Group under clause (i)(I).''.
    (b) Voiding of Proposed Case Mix Adjustment.--The Secretary of 
Health and Human Services shall not take any action to implement or 
otherwise carry out provisions contained in the final rule published on 
August 29, 2007, on pages 49762-49945 of volume 72 of the Federal 
Register, insofar as such provisions propose to make a case mix 
adjustment to the standardized payment amounts under the prospective 
payment system for home health services under section 1895 of the 
Social Security Act (42 U.S.C. 1395fff) to account for changes in 
coding that were not related to an underlying change in patient health 
status. The Secretary shall republish any rates specified in such rule 
to take into account the application of the previous sentence. The 
Secretary shall only institute an adjustment under subparagraph (B)(iv) 
of such section in compliance with subparagraph (D) of such section, as 
added by subsection (a)(2).
                                 <all>