Text: H.R.5803 — 111th Congress (2009-2010)All Bill Information (Except Text)

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Introduced in House (07/21/2010)

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[Congressional Bills 111th Congress]
[From the U.S. Government Printing Office]
[H.R. 5803 Introduced in House (IH)]

  2d Session
                                H. R. 5803

  To amend title XVIII of the Social Security Act to protect Medicare 
   beneficiaries' access to home health services under the Medicare 



                             July 21, 2010

Mr. McGovern (for himself and Mr. Jones) 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 


                                 A BILL

  To amend title XVIII of the Social Security Act to protect Medicare 
   beneficiaries' access to home health services under the Medicare 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,


    This Act may be cited as the ``Home Health Care Access Protection 
Act of 2010''.


    Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C. 
1395fff(b)(3)(B)), as amended by section 3401(e) of the Patient 
Protection and Affordable Care Act, 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 case mix changes 
                        for 2011 and later.--
                                    ``(I) In general.--The adjustment 
                                under clause (iv) shall only be made 
                                for years beginning with 2011 using 
                                standards developed by the Secretary 
                                consistent with the processes described 
                                in subclause (II) taking into account 
                                the criteria described in subclause 
                                    ``(II) Processes and criteria for 
                                evaluating changes in case mix.--For 
                                purposes of subclause (I), the 
                                processes described in this subclause 
                                are the following:
                                            ``(aa) In developing 
                                        standards referred to in such 
                                        subclause, the Secretary shall 
                                        convene a Technical Advisory 
                                        Group consisting of 
                                        stakeholders, including 
                                        individuals and organizations 
                                        representing the interests of 
                                        Medicare beneficiaries, the 
                                        home health community, health 
                                        care academia, and health care 
                                        professionals, in equal numbers 
                                        from each and limited to 
                                        parties without an existing 
                                        contractual relationship with 
                                        the Secretary, to advise the 
                                        Secretary concerning the 
                                        establishment of such standards 
                                        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 given the 
                                        opportunity to review and 
                                        comment on any proposed 
                                        rulemaking or final 
                                        determination by the Secretary 
                                        on such standards prior to such 
                                        rulemaking or 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 a 
                                        contractor that has not 
                                        previously participated in the 
                                        design and establishment of the 
                                        case mix adjustment factors 
                                        under this subparagraph.
                                            ``(cc) If the Secretary 
                                        determines that any increase in 
                                        case mix relates to changes in 
                                        the volume or nature of 
                                        services provided to home 
                                        health services patients, the 
                                        Secretary shall evaluate such 
                                        increase through 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 the standards 
                                        referred to in item (aa) by 
                                            ``(ee) With respect to 
                                        establishment of such 
                                        standards, the Secretary shall 
                                        make public all data, reports, 
                                        and supporting materials, 
                                        including any comments by the 
                                        Technical Advisory Group 
                                        pursuant to item (aa), 
                                        regarding the standards at the 
                                        time of notice of such 
                                    ``(III) Criteria.--The criteria 
                                described in this subclause are the 
                                            ``(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 
                                        health care services by 
                                        providers of services other 
                                        than home health agencies.
                                            ``(cc) Distinctions in the 
                                        characteristics of individuals 
                                        initiating home health services 
                                        from the community and 
                                        institutional care settings.
                                            ``(dd) Whether any changes 
                                        in coding resulted in a change 
                                        in expenditures overall 
                                        annually and disregarding 
                                        changes in coding that do not 
                                        have an overall expenditure 
                                            ``(ee) Any other factors 
                                        determined appropriate by the 
                                        Secretary in consultation with 
                                        the Technical Advisory Group 
                                        under subclause (II)(aa).''.