[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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