H.R.5163 - Home Health Refinement Amendments of 2000106th Congress (1999-2000)
|Sponsor:||Rep. McGovern, James P. [D-MA-3] (Introduced 09/13/2000)|
|Committees:||House - Commerce; Ways and Means|
|Latest Action:||10/19/2000 Referred to the Subcommittee on Health and Environment.|
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Text: H.R.5163 — 106th Congress (1999-2000)All Bill Information (Except Text)
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Introduced in House (09/13/2000)
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[Congressional Bills 106th Congress] [From the U.S. Government Printing Office] [H.R. 5163 Introduced in House (IH)] 106th CONGRESS 2d Session H. R. 5163 To amend title XVIII of the Social Security Act with respect to payments made under the prospective payment system for home health services furnished under the Medicare Program. _______________________________________________________________________ IN THE HOUSE OF REPRESENTATIVES September 13, 2000 Mr. McGovern (for himself, Mr. Peterson of Pennsylvania, Mr. Hilliard, Mr. Watkins, Mr. Jefferson, Mr. English, Mr. McIntosh, Mrs. Thurman, Mr. Hilleary, Mr. Weygand, Mr. Sanders, Mr. Cook, Mr. Rahall, Mr. Tierney, Mr. Moakley, Mr. Wamp, Mr. Pomeroy, Mr. Conyers, Mr. Goode, Mr. Dickey, Mr. Doyle, Mr. Frank of Massachusetts, Mr. Ney, Ms. Millender-McDonald, Mr. Romero-Barcelo, Mr. Frost, Mr. Kind, Mr. Baldacci, Mr. Olver, Mr. Murtha, Mr. Goodling, and Mr. Allen) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on 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 with respect to payments made under the prospective payment system for home health services furnished under the Medicare Program. 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 ``Home Health Refinement Amendments of 2000''. SEC. 2. ELIMINATION OF 15 PERCENT REDUCTION IN PAYMENT RATES UNDER THE MEDICARE PROSPECTIVE PAYMENT SYSTEM FOR HOME HEALTH SERVICES. (a) In General.--Section 1895(b)(3)(A) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(A)), as amended by sections 302(b) and 303(f) of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-359, 361), as enacted into law by section 1000(a)(6) of Public Law 106-113, is amended to read as follows: ``(A) Initial basis.--Under such system the Secretary shall provide for computation of a standard prospective payment amount (or amounts). Such amount (or amounts) shall initially be based on the most current audited cost report data available to the Secretary and shall be computed in a manner so that the total amounts payable under the system for the 12-month period beginning on the date the Secretary implements the system shall be equal to the total amount that would have been made if the system had not been in effect and if section 1861(v)(1)(L)(ix) had not been enacted. Each such amount shall be standardized in a manner that eliminates the effect of variations in relative case mix and area wage adjustments among different home health agencies in a budget neutral manner consistent with the case mix and wage level adjustments provided under paragraph (4)(A). Under the system, the Secretary may recognize regional differences or differences based upon whether or not the services or agency are in an urbanized area.''. (b) Effective Date.--The amendment made by subsection (a) shall take effect as if included in the enactment of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106-113). SEC. 3. ADDITIONAL PAYMENTS FOR OUTLIERS. (a) In General.--Section 1895(b)(5) of the Social Security Act (42 U.S.C. 1395fff(b)(5)) is amended-- (1) by striking ``Outliers.--The Secretary'' and inserting the following (and conforming the indentation of the succeeding matter accordingly): ``Outliers.-- ``(A) In general.--The Secretary''; and (2) by adding at the end the following new subparagraph: ``(B) Temporary additional payments for outliers.-- For the purposes described in the first sentence of subparagraph (A), there are authorized to be appropriated from the trust funds (as defined in section 1896(a)(8)) in appropriate part, as determined by the Secretary, for each of fiscal years 2001 through 2005 an amount equal to $500,000,000. Such amounts shall be in addition to amounts available for payment under this section and shall not result in an reduction of the standard prospective payment amount (or amounts). In making payments under this subparagraph, the Secretary shall use a loss-sharing ratio of 90 percent.''. (b) Conforming Amendment.--Section 1895(b)(3)(C) of such Act (42 U.S.C. 1395fff(b)(3)(C)) is amended by striking ``paragraph (5)'' and inserting ``paragraph (5)(A)''. SEC. 4. ADDITIONAL PAYMENTS UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR SERVICES FURNISHED IN RURAL AREAS AND SECURITY SERVICES. (a) Increase in Payment Rates for Rural Agencies.--Section 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)) is amended by adding at the end the following new paragraph: ``(7) Additional payment amount for services furnished in rural areas.--In the case of home health services furnished in a rural area (as defined in section 1886(d)(2)(D)), notwithstanding any other provision of this subsection, the amount of payment for such services is equal to 110 percent of the payment amount otherwise made under this section (but for this paragraph) for services furnished in a rural area.''. (b) Additional Payment for Security Services.--Section 1895(b) of such Act (42 U.S.C. 1395fff(b)(3)), as amended by subsection (a), is further amended by adding at the end the following paragraph: ``(8) Additional payment for security services.--The Secretary shall provide for an addition or adjustment to the payment amount otherwise made under this section for the reasonable cost (as defined in section 1861(v)(1)(A)) of furnishing protective services to individuals furnishing home health services under this title in areas where such individuals are at risk of physical harm, as determined by the Secretary.''. (c) Inapplicability of Adjustments for Budget Neutrality.--Section 1895(b)(3) of such Act (42 U.S.C. 1395fff(b)(3)) is amended by adding at the end the following new subparagraph: ``(D) No adjustment for additional payments for rural services and security services.--The Secretary shall not reduce the standard prospective payment amount (or amounts) under this paragraph applicable to home health services furnished during a period to offset the increase in payments resulting from the application of paragraph (7) (relating to services furnished in rural areas) and paragraph (8) (relating to costs of security services).''. (d) Effective Date.--The amendments made by this section apply with respect to items and services furnished on or after October 1, 2000. SEC. 5. EXCLUSION OF NONROUTINE MEDICAL SUPPLIES UNDER THE PPS FOR HOME HEALTH SERVICES. (a) In General.--Section 1895 of the Social Security Act (42 U.S.C. 1395fff) is amended by adding at the end the following new subsection: ``(e) Exclusion of Nonroutine Medical Supplies.-- ``(1) In general.--Notwithstanding the preceding provisions of this section, in the case of all nonroutine medical supplies (as defined by the Secretary) furnished by a home health agency during a year (beginning with 2001) for which payment is otherwise made on the basis of the prospective payment amount under this section, payment under this section shall instead be based on the lesser of-- ``(A) the actual charge for the nonroutine medical supply, or ``(B) the amount determined for such supply under the applicable fee schedule under part B. ``(2) Budget neutrality adjustment.--The Secretary shall provide for an appropriate proportional reduction in payments under this section so that beginning with fiscal year 2001, the aggregate amount of such reductions is equal to the aggregate increase in payments (as estimated by the Secretary) attributable to the exclusion effected under paragraph (1).''. (b) Conforming Amendments.--(1) Section 1895(b)(1) of the Social Security Act (42 U.S.C. 1395fff(b)(1)) is amended by striking ``The Secretary'' and inserting ``Subject to subsection (e), the Secretary''. (2) Sections 1842(b)(6)(F) and 1862(a)(21) of the Social Security Act (42 U.S.C. 1395u(b)(6)(F); 1395y(a)(21)) are each amended by striking ``(including medical supplies described in section 1861(m)(5), but excluding durable medical equipment to the extent provided for in such section)'' and inserting ``(other than medical supplies and durable medical equipment described in section 1861(m)(5))''. (c) Effective Date.--The amendments made by this section apply with respect to items and services furnished on or after October 1, 2000. SEC. 6. RULE OF CONSTRUCTION RELATING TO TELEHOMEHEALTH SERVICES. (a) In General.--Section 1895(b) of such Act (42 U.S.C. 1395fff(b)(3)), as amended by section 3, is further amended by adding at the end the following paragraph: ``(9) Rule of construction relating to telehomehealth services.-- ``(A) In general.--Nothing in this section, or in section 4206(a) of the Balanced Budget Act of 1997 (42 U.S.C. 1395l note), shall be construed as preventing a home health agency receiving payment under this section from furnishing a home health service via a telecommunications system. Each home health agency that submits a cost report to the Secretary under this section shall include, in such cost report, data with respect to the costs incurred in furnishing home health services to medicare beneficiaries via such telecommunications systems. ``(B) Limitation.--The Secretary shall not consider a home health service provided in the manner described in subparagraph (A) to be a home health visit for purposes of-- ``(i) determining the amount of payment to be made under this section; or ``(ii) any requirement relating to the certification of a physician required under section 1814(a)(2)(C).''. (b) Report.--Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report containing the recommendations of the Secretary with respect to the feasibility and advisability of including home health services furnished by telecommunications systems as a home health service for purposes of-- (1) payment for such services under section 1895 of the Social Security Act (42 U.S.C. 1395fff), and (2) requirements with respect to physician certification of the need for home health services under section 1814(a)(2)(C) of such Act (42 U.S.C. 1395f(a)(2)(C)). <all>