I 111th CONGRESS 1st Session H. R. 3495 IN THE HOUSE OF REPRESENTATIVES July 31, 2009 Ms. Kaptur 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 ensure access to quality home health services for all Americans, and for other purposes.

1.

Short title; purpose

(a)

Short title

This Act may be cited as the Preserving Equitable Access to Community-based Home Health (PEACH) Act of 2009. (b)

Purpose

It is the purpose of this Act to preserve access to home health services for all Americans, regardless of their ability to pay or their severity of illness.

2.

Findings

The Congress finds the following: (1)The Medicare home health benefit is vulnerable to agency selection of the most profitable beneficiaries and avoidance of the most complex and costly beneficiaries. (2)Such cherry picking by some home health agencies compromises access to care for the most complex, highest risk beneficiaries. (3)The Government Accountability Office has reported that hospital discharge planners have difficulty placing more than 10 percent of eligible patients in home health due to their extensive care needs. (4)Proposals to reduce Medicare payments to home health agencies (in response to large aggregate margins across all home health agencies) may undermine the financial viability of mission-driven and non-profit home health agencies, which often have low to negative margins, while allowing high-margin agencies to remain in operation.

3.

Supplemental payments for peach agencies

(a)

In general

There shall be established a fund (to be known as the PEACH fund) from which home health agencies meeting specified criteria shall be paid supplemental amounts in addition to their statutory payment amounts under title XVIII of the Social Security Act. Is this to be a trust fund? Where is this fund to be established? Who adminsters it? What are the sources of funding that goes into the fund? What are the allowed uses of such funding? (b)

Peach program

Title XVIII of the Social Security Act is amended by inserting after section 1895 the following new section:

1895A.

Supplemental payments for peach agencies

(a)

Designation

(1)

In general

The Secretary shall designate as a PEACH agency any home health agency that meets the criteria under paragraph (2). (2)

Criteria

The Secretary may not designate a home health agency as a PEACH agency unless the home health agency meets the following criteria: (A)The home health agency is certified for participation under this title. (B)The home health agency offers— (i)the complete range of home health services as defined under section 1861(m) of this title; (ii)the complete range of home health services on a 24 hours per day, 7 days per week on-call basis; and (iii)its services to all eligible beneficiaries or enrollees under this title and/or title XIX, and uninsured individuals up to its service capacity, regardless of their ability to pay or the complexity or intensity of care they require. (C)The home health agency provides charity care in an amount greater than or equal to 1 percent of its total revenue. (D)The home health agency agrees that the Secretary may, by statistical or other means, verify on an annual basis that the agency meets the criteria defined in this paragraph, and that the agency will be subject to disqualification from the PEACH program if such criteria are not met. (b)

Supplemental payments

(1)

In general

Subject to the availability of funds under subsection (c), the Secretary shall make supplemental payments to PEACH agencies based on information submitted by the agency on an additional schedule in the Medicare cost report. (2)

Cost reporting

The Secretary shall implement an additional schedule, as a component of the cost reporting process, on which home health agencies may report information the Secretary deems necessary for designation and payment as a PEACH agency. (3)

Amount and timing for first year as peach agency

(A)The supplemental payment made to a home health agency for the first year in which such agency is designated a PEACH agency under this section shall be equal to its shortfall in that year, defined as the sum of— (i)the aggregate reasonable cost of home health services delivered under parts A and B of this title by the PEACH agency for such year, less the aggregate payments received by the PEACH agency pursuant to section 1895; (ii)the aggregate actual costs of home health and home and community based services delivered by the agency under sections 1905(a)(7), 1905(a)(22), and 1915(c) through (e) of title XIX for such year, less the aggregate payments received by the PEACH agency for such services under that title; and (iii)the aggregate cost of uncompensated home health services delivered by the PEACH agency for such year. (B)The supplemental payment under subparagraph (A) shall be paid within 90 days of receipt of the annual cost report by the Secretary. (4)

Amount and timing for subsequent years

For each year after the first year in which a home health agency is designated a PEACH agency, a PEACH agency shall receive interim supplemental payments based on— (A)the intervals at which the agency submits cost reports; and (B)the estimated shortfall, as defined in subparagraph (3)(A), for the year or interval in question. (c)

Funding

Supplemental payments under this section shall be— (1)paid from the PEACH fund, which shall be capped at $500,000,000 annually and shall be administered by the Secretary; and (2)paid to PEACH agencies— (A)pursuant to subsection (b); or (B)if the PEACH fund is insufficient to cover all the supplemental payments that should be paid under subsection (b), in proportion to each agency’s shortfall relative to the aggregate shortfall of all PEACH agencies for the year in question. In any year in which the Secretary determines that the PEACH fund will not cover the aggregate estimated shortfall of all PEACH agencies, the Secretary shall make a preliminary supplemental payment to each PEACH agency within 90 days of receipt of its annual cost report and, if funds remain, an additional supplemental payment after all PEACH agency cost reports have been received.(d)

Definitions

For purposes of this section— (1)the term charity care means home health services that are provided to an individual who is— (A)not eligible for payment under this title, under title XIX, or by any other third-party payer; and (B)unable to pay any portion of the full cost of care, including any amount subsidized or otherwise discounted due to an individual’s inability to pay; and (2)the term uncompensated care means home health services provided to an individual by a home health agency with the knowledge that the individual will be financially unable to pay for the services.

. (c)

Conforming amendment

Section 1895(a) of the Social Security Act is amended by inserting before the period at the end the following: and the provisions of section 1895A.

4.

Regulations

The Secretary shall issue such regulations as are necessary and appropriate for the implementation of the provisions of this Act.

5.

Authorization of appropriations

There is authorized for appropriation $500,000,000 for each fiscal year beginning with fiscal year 2010 for purposes of carrying out the purposes of this Act. Is there anything this funds other than the PEACH fund? Should this go into the provision creating that fund?