A bill to direct the Secretary of Health and Human Services to make additional payments under the Medicare program to certain home health agencies with high-cost patients, to provide for an interest-free grace period for the repayment of overpayments made

10 Pages·1999·0.33 MB·English

by  United States. Congress. House

I
106thcongress H.R.1917
1stSession
Todirectthe SecretaryofHealth andHuman Servicestomakeadditional
paymentsundertheMedicareProgramtocertainhomehealthagencies
\vith high-costpatients,toprovideforan interest-freegraceperiodfor
the repajTTientofoverpaymentsmadebythe Secretan,-to homehealth
agencies,andforotherpurposes.
IN THE HOUSE OF REPRESENTATIVES
May25,1999
Mr.McGo\TERX (forhimself, Mr. COBURX,Mr.Weygaxd, Mr. Bartonof
Texas,Mr.McIntosh,Mr.Rahall,Mr.Hilleary,Ms.HooleyofOr-
egon, Mr. Wamp, and Mr. ACKERMAN) introduced the following bill;
whichwasreferredtotheCommitteeonWaysandMeans,andinaddi-
tiontotheCommitteeonCommerce,foraperiodtobesubsequentlyde-
terminedbytheSpeaker,ineachcaseforconsiderationofsuchprovisions
asfallwithinthejurisdictionofthecommitteeconcerned
A
BILL
To direct the Secretary of Health and Human Services to
make additional payments under the Medicare Program
to certain home health agencies with high-cost patients,
toprovideforaninterest-freegraceperiodfortherepay-
ment of overpajnnents made by the Secretary to home
healthagencies,andforotherpurposes.
1 BeitenactedhytheSenateandHouseofRepresenta-
2 tivesoftheUnitedStatesofAmericainCongressassembled,
2
1 SECTION1.SHORTTITLE.
2 ThisActmaybecited asthe ''HomeHealthAccess
3 PreservationActof1999".
4 SEC.2.ADDITIONALPAYMENTSTOAGENCIESFORMOST
5 EXPENSIVECASES.
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6 (a)Pay^iextsforOutliers.
7 (1) Ix GEXERAL.—Subject to paragraph (2),
8 from amounts appropriated pursuant to subsection
9 (e), the Secretary of Health and Human Services
10 shallpayanadditionalamounttohomehealthagen-
11 ciesfamishingqualifiedhomehealthservicesduring
12 a cost reportingperiod beginning on or after Octo-
13 ber 1, 1997, under the medicare program (under
XVm
14 title oftheSocialSecurityAct).
15 (2) Llmitatiox of paymexts.—No payment
16 shall be made under this section to a home health
17 agencythat, as ofthedate ofthe enactmentofthis
18 Act, has ceased furnishinghome health services for
19 which payment may be made under the medicare
20 program(undersuchtitle).
21 (b) Descriftiox of Qualified SER\acES.—For
22 purposes ofadditional payment amounts under this sec-
23 tion bythe Secretaryto home health agencies, qualified
24 home health services are home health services famished
25 underthe medicare program for the treatment ofcondi-
26 tionswithinadiagnosisdescribedinsubsection(c).
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3
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1 (c) Description of Diagnosis. diagnosis de-
2 scribedinthissubsectionisoneofthefollowingdiagnoses
« 3 as classified in St.Anthony'sICD-9-CM Code Bookfor
• 4 PhysicianPayment:
5 (1)diabetesmeUitus(ICD-9-CMcode250).
6 (2) essential hypertension (ICD-9-CM code
7 401).
8 (3) other forms ofchronic ischemic heart dis-
9 ease(ICD-9-CMcode414).
10 (4)heartfailure(ICD-9-CMcode428).
11 (5) acute,butill-definedcerebrovasculardisease
12 (ICD-9-CMcode436).
13 (6) pneumonia, organism unspecified (ICD-9-
14 CMcode486).
15 (7) chronic airway obstruction, not elsewhere
16 classified(ICD-9-CMcode496).
17 (8) chronic ulcer of skin (ICD-9-CM code
18 707).
19 (9) symptoms involving urinary system (ICD-
20 9-CMcode788).
21 (10) fracture of neck of femur (ICD-9-CM
22 code820).
23 (d) DETEmiiNATioN of Agency-Specific Pay-
t 24 MEXTAilOUNT.
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4
1 (1) Certification of quantity of quali-
2 fiedhomehealthser^^cesfurnished.
—
3 (A) Ingeneral. ^Withrespectto afiscal
4 year, a home health agencymay submitto the
5 Secretary a certification ofthe number ofpa-
6 tients to whom the agency famished quahfied
7 home health services during the agency's cost
8 reportingperiodbeginninginthatfiscalyear.
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9 (B)Deadlineforsubmission.
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10 (i) In general. Such certification
11 shallbe submittedto the Secretaryduring
12 the 30-day period beginning on the date
13 theagencysubmitstothe Secretaryacost
14 report forthe cost reportingperiodbegin-
15 ninginsuchfiscalyear.
—
16 (ii) Transition rule. ^In the case
17 ofan agencywith a cost reportingperiod
18 beginning on or after October 1, 1997,
19 thatendsbeforethedateofthe enactment
20 ofthis Act, with respect to such cost re-
21 porting period, the 30-day period under
22 clause (i) begins 60 days afterthe date of
23 theenactmentofthisAct.
24 (2) Determination of aggregate quali-
25 FIED home HEALTH SER\aCES FURNISHED.—From
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1 data contained in certifications submitted under
2 paragraph (1)withrespectto costreportingperiods
3 beginninginfiscalyears 1998, 1999, and 2000, the
4 Secretary shall determine, with respect to a fiscal
5 year, the number of patients who have received
6 qualifiedhomehealth services fiimishedbyagencies
7 submitting such certifications for that fiscal year.
8 The Secretaryshallmakesuchdeterminationbynot
9 later than 120 days after all cost reports for that
10 fiscalyearhavebeenreceived.
11 (3) Agency-specific percentage ofaggre-
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12 GATE AMOUNT. ^For each home health agencysub-
13 mittingacertificationunderparagraph (1) forafis-
14 cal year described in paragraph (2), the Secretary
15 shaU determine an agency-specific percentage bydi-
16 vidingthe numberofpatients certifiedbythe home
17 health agency for that fiscal year by the national
18 total specified inparagraph (2) forthat fiscalyear.
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19 (4) Pa^^ient amount. The Secretary shall
20 pay for a fiscal year described in paragraph (2) to
21 ahomehealthagencymakingthecertificationunder
22 paragraph(1) anamountequaltotheproductofthe
23 percentage determinedunderparagraph (3) andthe
24 amountappropriatedforsuchfiscalyearundersub-
25 section(e).
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1 (e)AuthorizationofAppropriations. Thereis
2 authorizedtobe appropriatedfromthe FederalHospital
3 InsuranceTrustFund(estabhshedundersection 1817of
4 theSocialSecurityAct(42U.S.C. 1395i))formakingad-
5 ditionalpaymentstohomehealthagenciesunderthissec-
6 tion, $250,000,000 in each of the fiscal years 2000
7 through2002.
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8 (f)Termination. TheSecretaryshallnotmakead-
9 ditionalpaymentsunderthissectionforcostreportingpe-
10 riods, orportions ofcostreportingperiods, beginningon
11 orafterthedateoftheimplementationoftheprospective
12 payment system for home health services under section
13 1895oftheSocialSecurityAct(42U.S.C.1395fef).
14 (g) LimitationonJudicialReview.—Thereshall
15 benoadministrativeorjudicialreviewundersection1869
16 of the Social Security Act (42 U.S.C. 1395ff), section
17 1878ofsuchAct(42U.S.C. 1395oo),orotherwiseofany
18 actionofthe Secretarywithrespectto the determination
19 ofanadditionalpaymentamountunderthissection.
20 SEC.3.OVERPAYMENTS.
21 (a) 36-MoNTHRepay^ientPeriod.—Inthecaseof
22 an overpaymentbythe SecretaryofHealth andHuman
23 Servicestoahomehealthagencyforhomehealthservices
24 furnished duringacostreportingperiodbeginningonor
25 afterOctober 1, 1997, as aresultofpaymentlimitations
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1 provided for under clause (v), (vi), or (viii) of section
2 1861(v)(l)(L) of the Social Security Act (42 U.S.C.
3 1395x(v)(l)(L)), the home health agency may elect to
4 repaythe amount ofsuch overpayment over a 36-month
5 periodbeginningonthedateofnotificationofsuchover-
6 pajnnent.
7 (b)InterestonOverpaymentAiiouNTS.
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8 (1) 36-MONTHgraceperiod.
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9 (A) Ingeneral. ^Inthecaseofanagen-
10 cythatmakes anelectionundersubsection (a),
11 nointerestshallaccrueontheoutstandingbal-
12 anceoftheamountofoverpaymentduringsuch
13 36-monthperiod.
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14 (B) Overdue balances. In the case of
15 such an agency, interest shall accrue on any
16 outstandingbalance ofthe amount ofoverpay-
17 ment after termination of such 36-month pe-
18 riod. Interest shall accrue under this subpara-
19 graph at the rate ofinterest chargedbybanks
20 forloanstotheirmostfavoredcommercial cus-
21 tomers, aspublishedintheWaU StreetJournal
22 ontheFridayimmediatelyfollowingthedateof
23 theenactmentofthisAct.
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24 (2) Otheragencies. Inthecaseofanagen-
25 cydescribedinsubsection (a) thatdoesnotmakean
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1 election under subsection (a), interest shall accrue
2 on the outstandingbalance ofthe amount ofover-
3 paymentattheratedescribedinthesecondsentence
4 ofparagraph(1)(B)
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5 (c) Termination. Noelectionundersubsection (a)
6 maybemadeforcostreportingperiods,orportionsofcost
7 reportingperiods, beginning on or after the date ofthe
8 implementation of the prospective payment system for
9 homehealthservicesundersection 1895oftheSocialSe-
10 curityAct(42U.S.C. 1395fff).
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11 (d)EffectiveDate. Theprovisionsofsubsection
12 (a) shalltakeeffectasifincludedintheenactmentofthe
13 BalancedBudgetActof1997
14 SEC. 4. UPDATE ON IMPLEMENTATION OF PROSPECTIVE
15 PAYMENTSYSTEMFORHOMEHEALTHAGEN-
16 CIES.
17 Not laterthan 90 days afterthe date ofenactment
18 ofthisAct,andevery90daysthereafteruntiltheprospec-
19 tivepaymentsystemforhomehealthagencies(estabhshed
20 by section 1895 of the Social Security Act (42 U.S.C.
21 1395fff)) is implemented, the Secretary of Health and
22 Human Services shall meet with the staffofthe appro-
23 priatecommitteesofCongresstoprovideaninformalup-
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1 date regarding the progress of the Secretary m imple-
2 mentingsuchpaymentsystem.
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