1.This Act may be cited as
the Home Health Care Access Protection
Act of 2011
.
2.Protecting
access to medicare home health servicesSection 1895(b)(3)(B) of the Social Security
Act (42 U.S.C. 1395fff(b)(3)(B)) is amended—
(1)in clause (iv),
by striking Insofar as
and inserting Subject to clause
(vii), insofar as
; and
(2)by adding at the
end the following new clause:
(vii)Special rules
for adjustment for case mix changes for 2012 and subsequent years
(I)For 2012 and each subsequent year, subject to subclause
(IV), any adjustment under clause (iv) shall only be made using standards
established by the Secretary consistent with the processes described in
subclause (II) and taking into account the considerations described in
subclause (III).
(II)Processes and
criteria for evaluating changes in case mixFor purposes of
subclause (I), the processes described in this subclause are the
following:
- (aa)The Secretary
shall convene a Technical Advisory Group to advise the Secretary concerning the
establishment of standards under subclause (I) 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 composed of stakeholders, including an equal number of
individuals and organizations representing the interests of Medicare
beneficiaries, the National Association for Home Care and Hospice, the Visiting
Nurse Associations of America, health care academia, and health care
professionals. Members shall not have an existing contractual relationship with
the Secretary at the time of their appointment to the Technical Advisory Group.
The Secretary shall provide the Technical Advisory Group an opportunity to
review and comment on any proposed rulemaking or final determination of the
Secretary with respect to such standards prior to the issuance of the proposed
rulemaking or making of the final determination.
- (bb)If the Secretary
engages an outside contractor to participate in the evaluation of case mix
changes described in item (aa), the Secretary shall only utilize an outside
contractor that has not previously participated in the design and establishment
of the case mix adjustment factors under paragraph (4)(B).
- (cc)If the Secretary
determines that any increase in case mix relates to changes in the volume or
nature of home health services provided, the Secretary shall evaluate that
increase through the 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.
- (dd)The Secretary
shall establish such standards by regulation.
- (ee)The Secretary
shall make available to the public all data, reports, and supporting materials,
including any comments by the Technical Advisory Group under item (aa),
regarding the establishment of such standards at the time of the publication of
the notice of the proposed regulation.
(III)For
purposes of subclause (I), the considerations described in this subclause are
the following:
- (aa)The impact of
changes in the program under this title that may affect the characteristics of
individuals receiving home health services.
- (bb)The impact of
changes in the provision of home health services by providers of services and
suppliers other than home health agencies.
- (cc)Distinctions in
the characteristics of individuals initiating home health services from
community and institutional care settings.
- (dd)Whether any
changes in coding resulted in a change in aggregate payments under this
subsection during the fiscal year or year and disregarding changes in coding
that did not result in such a change in aggregate payments.
- (ee)Any other
factors determined appropriate by the Secretary, in consultation with the
Technical Advisory Group under subclause (II)(aa).
(IV)Exception for
certain adjustments for 2012This clause shall not apply to any
adjustment under clause (iv) that is scheduled in a final rule for 2012 as of
January 1,
2011.
.