[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5110 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 5110

 To amend title XVIII of the Social Security Act to repeal rebasing of 
   payments for home health services, as required under the Patient 
Protection and Affordable Care Act, and to replace such rebasing with a 
  Medicare home health value-based purchasing program, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 15, 2014

   Mr. Walden (for himself, Mr. Price of Georgia, Mrs. Ellmers, Mr. 
 McKinley, Mr. Latham, Mr. Duffy, Mrs. McMorris Rodgers, Mr. Graves of 
Missouri, Mr. Boustany, Mr. Paulsen, Mr. Thompson of Pennsylvania, Mr. 
Young of Alaska, and Mr. Gardner) 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 repeal rebasing of 
   payments for home health services, as required under the Patient 
Protection and Affordable Care Act, and to replace such rebasing with a 
  Medicare home health value-based purchasing program, and for other 
                               purposes.

    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 ``Securing Access Via Excellence for 
Medicare Home Health Act of 2014'' or the ``SAVE Medicare Home Health 
Act of 2014''.

SEC. 2. REPEAL OF MEDICARE HOME HEALTH REBASING REDUCTION PROVIDED 
              UNDER PPACA AND DETAILED ANALYSIS OF SUCH REDUCTION.

    (a) Repeal of Rebasing Reduction and Codification of CY 2014 
Payment Adjustment.--
            (1) Repeal.--Section 1895(b)(3)(A) of the Social Security 
        Act (42 U.S.C. 1395fff(b)(3)(A)) is amended by striking clause 
        (iii).
            (2) Codification.--Such section, as amended by paragraph 
        (1), is further amended by adding at the end the following new 
        clause:
                            ``(iii) Codification of cy 2014 payment 
                        adjustment.--The amount (or amounts) that would 
                        otherwise be applicable under clause (i)(III) 
                        for 2015 and subsequent years shall be 
                        determined taking into account the 3.5 
                        percentage point reduction effective for 2014 
                        pursuant to the rule for home health 
                        prospective payment system rate update for 
                        calendar year 2014 (promulgated on December 2, 
                        2013, 78 Federal Register 72256).''.
    (b) Detailed Analysis of Rebasing Reduction.--
            (1) In general.--The Secretary of Health and Human Services 
        shall conduct a detailed analysis of the rebasing reduction in 
        Medicare payments for home health services promulgated under 
        the rule for home health prospective payment system rate update 
        for calendar year 2014 (promulgated on December 2, 2013, 78 
        Federal Register 72256), pursuant to the Regulatory Flexibility 
        Act, Executive Order 13563, section 3131(a) of the Patient 
        Protection and Affordable Care Act, and other specified 
        factors. Such analysis shall include an assessment of at least 
        the following factors:
                    (A) The age, poverty level, gender, rural 
                residence, ethnic or racial minority, and infirmity of 
                Medicare beneficiaries receiving home health services 
                in comparison to other Medicare beneficiaries.
                    (B) The number, gender, and geographic distribution 
                of professional Medicare home health caregivers.
                    (C) The number and location of home health agencies 
                that have closed, consolidated, or been acquired since 
                the rebasing reduction was implemented.
                    (D) The number and location of professional home 
                health caregiver jobs that have been lost since the 
                rebasing reduction was implemented.
            (2) Report.--Not later than February 1, 2015, the Secretary 
        shall submit to Congress a report that contains findings 
        regarding the analysis conducted under paragraph (1), including 
        the Secretary's assessment of the factors specified in such 
        paragraph.

SEC. 3. ESTABLISHMENT OF HOME HEALTH VALUE-BASED PURCHASING (VBP) 
              PROGRAM.

    (a) Readmission Measures.--Section 1895 of the Social Security Act 
(42 U.S.C. 1395fff) is amended by adding at the end the following new 
subsection:
    ``(f) Post-Hospital Home Health Services Readmission Measure.--
            ``(1) Readmission measure.--Not later than January 1, 2016, 
        the Secretary shall specify a home health all-cause all-
        condition hospital unplanned readmission measure (or any 
        successor to such a measure) for readmissions (for any cause) 
        to a hospital for an individual who is entitled to benefits 
        under part A (or enrolled under part B) and who is receiving 
        post-hospital home health services.
            ``(2) Resource use measure.--Not later than January 1, 
        2017, the Secretary shall specify a measure that is the measure 
        specified under paragraph (1), risk-adjusted for potentially 
        preventable readmissions to a hospital for an individual 
        described in such paragraph.
            ``(3) Development.--The measures specified under paragraphs 
        (1) and (2) shall be developed through a formal process that is 
        based on input from a group of multiple stakeholders consisting 
        of at least senior advocates, Medicare beneficiaries, 
        caregivers, and home health physicians, nurses, therapists, and 
        operators of home health agencies.
            ``(4) Quarterly feedback reports to home health agencies.--
        Beginning January 1, 2017, and every quarter thereafter, the 
        Secretary shall provide confidential feedback to home health 
        agencies on their performance with respect to such measures.
            ``(5) Public reporting on performance.--
                    ``(A) In general.--Subject to subparagraphs (B) and 
                (C), the Secretary shall establish procedures for 
                making public on the Medicare Home Health Compare 
                website (or successor to such website) the performance 
                of home health agencies with respect to a measure 
                specified under paragraph (1) and a measure specified 
                under paragraph (2).
                    ``(B) Opportunity to review.--The procedures under 
                subparagraph (A) shall ensure that a home health agency 
                has the opportunity to review and submit corrections to 
                the information that is to be made public with respect 
                to such agency before such information is made public.
                    ``(C) Timing.--Such procedures shall provide that 
                the information described in subparagraph (A) is first 
                made publicly available beginning no later than January 
                1, 2018.''.
    (b) Value-Based Purchasing Program for Home Health Agencies.--
Section 1895 of the Social Security Act (42 U.S.C. 1395fff), as amended 
by subsection (a), is further amended by adding at the end the 
following new subsection:
    ``(g) Application of Value-Based Purchasing Program.--
            ``(1) Establishment.--
                    ``(A) In general.--Subject to the succeeding 
                provisions of this subsection, the Secretary shall 
                establish a home health agency value-based purchasing 
                program (in this subsection referred to as the `HHA VBP 
                Program') under which value-based incentive payments 
                are made in a year to home health agencies.
                    ``(B) Program to begin in 2019.--The HHA VBP 
                Program shall apply to payments for episodes of home 
                health services beginning on or after January 1, 2019.
            ``(2) Application of measures.----
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretary shall apply the measure specified under 
                subsection (f)(2) for purposes of the HHA VBP Program.
                    ``(B) Replacement.--If the Secretary determines 
                that the application of such measure is not practicable 
                and should be delayed and the Secretary notifies the 
                Committee on Finance of the Senate and the Committees 
                on Ways and Means and Energy and Commerce of the House 
                of Representatives of the reasons for such delay in 
                advance of implementing such delay, the Secretary may 
                delay the application of such measure for a period of 
                up to 1 year. For the period of any such delay, the 
                measure specified under subsection (f)(1) shall apply 
                for purposes of the HHA VBP Program instead of the 
                measure specified under subsection (f)(2).
            ``(3) Performance standards.--
                    ``(A) Establishment.--The Secretary shall establish 
                performance standards with respect to the measure 
                applied under paragraph (2) for a performance period 
                for a year.
                    ``(B) Higher of achievement and improvement.--The 
                performance standards established under subparagraph 
                (A) shall include levels of achievement and 
                improvement. In calculating the HHA performance score 
                under paragraph (4), the Secretary shall use the higher 
                of either improvement or achievement.
                    ``(C) Timing.--The Secretary shall establish and 
                announce the performance standards established under 
                subparagraph (A) not later than 60 days before the 
                beginning of the performance period for the year 
                involved.
            ``(4) HHA performance score.--
                    ``(A) In general.--The Secretary shall develop by 
                regulation a methodology for assessing the total 
                performance of each home health agency based on 
                performance standards established under paragraph (3) 
                with respect to the measure applied under paragraph 
                (2). Using such methodology, the Secretary shall 
                provide for an assessment (in this subsection referred 
                to as the `HHA performance score') for each home health 
                agency for each such performance period.
                    ``(B) Ranking of hha performance scores.--The 
                Secretary shall, for the performance period for each 
                year, rank the HHA performance scores determined under 
                subparagraph (A) from low to high.
            ``(5) Budget neutral withholding.--The Secretary shall 
        withhold from the payment rates made for each year (during the 
        period beginning with 2019 and ending with 2024) for home 
        health services under this section such withholding percentage 
        as is necessary so that the enactment of the Securing Access 
        Via Excellence for Medicare Home Health Act of 2014 is 
        estimated not to result in any net change in payments made for 
        such services under this title.
            ``(6) Value-based incentive payment percentage.--The 
        Secretary shall provide for a distribution of a portion of the 
        amounts withheld under paragraph (5) for performance payments 
        to home health agencies in a manner so as to ensure that--
                    ``(A) the distribution (expressed as a percentage 
                of such withheld amounts) is based on each agency's HHA 
                performance ranking under paragraph (4)(B) for the 
                performance period for the year involved;
                    ``(B) the application of all such percentages in 
                such year results in an appropriate distribution of 
                value-based incentive payments under this subsection 
                such that--
                            ``(i) home health agencies with the highest 
                        rankings under paragraph (4)(B) receive the 
                        highest value-based incentive payment amounts 
                        under this subsection;
                            ``(ii) home health agencies with the lowest 
                        rankings under paragraph (4)(B) receive the 
                        lowest value-based incentive payment amounts 
                        under this subsection; and
                            ``(iii) in the case of home health agencies 
                        in the lowest 40 percent of the ranking under 
                        paragraph (4)(B), the payment rate under this 
                        subsection for services furnished by such 
                        facility during such year shall be less than 
                        the payment rate for such services for such 
                        year that would otherwise apply without 
                        application of this subsection; and
                    ``(C) the total amount of value-based incentive 
                payments under this subsection for all home health 
                agencies in such year shall be greater than or equal to 
                50 percent, but not greater than 70 percent, of the 
                total amount of the payments withheld for such year 
                under paragraph (5), as estimated by the Secretary.
            ``(7) Announcement of result of adjustments.--Under the HHA 
        VBP program, the Secretary shall, not later than 60 days before 
        a year involved, inform each home health agency of the 
        adjustments to payments to the agency for services furnished by 
        the agency during the year under this subsection.
            ``(8) No effect in subsequent year.--The value-based 
        payment adjustments under this subsection shall only apply with 
        respect to the year involved, and the Secretary shall not take 
        into account such adjustment in making payments to a home 
        health agency under this section in a subsequent year.
            ``(9) Funding for program management.--The Secretary shall 
        provide for the one-time transfer from the Federal 
        Supplementary Medical Insurance Trust Fund established under 
        section 1841 to the Centers for Medicare & Medicaid Services 
        Program Management Account of--
                    ``(A) $2,000,000 for purposes of subsection (f); 
                and
                    ``(B) $10,000,000 for purposes of implementing this 
                subsection.
        Such funds shall remain available until expended.''.
    (c) MedPAC Study.--Not later than June 30, 2021, the Medicare 
Payment Advisory Commission shall submit to Congress a report that 
reviews the progress of the home health value-based purchasing program 
established under section 1895(g) of the Social Security Act, as added 
by subsection (b), and makes recommendations, as appropriate, on any 
improvements that should be made to such program. For purposes of the 
previous sentence, the Medicare Payment Advisory Commission shall 
consider any unintended consequences with respect to such home health 
agency value-based purchasing program and any potential adjustments to 
the readmission measure specified under section 1895(f) of such Act, as 
added by subsection (a), for purposes of determining the effect of the 
socio-economic status of a beneficiary under the Medicare program under 
title XVIII of the Social Security Act on the performance score of a 
home health agency provided under section 1895(g)(4) of such Act, as 
added by subsection (b).
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