1.This Act may be cited as
the Home Health Care Access Protection
Act of 2007
.
2.Protecting access
to Medicare home health services
(a)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 mixFor purposes of
subparagraph (B)(iv)—
(i)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)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 adjustmentThe 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).