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S 2181 IS
110th CONGRESS
1st Session
S. 2181
To amend title XVIII of the Social Security Act to protect Medicare beneficiaries' access to home health services under the Medicare program.
IN THE SENATE OF THE UNITED STATES
October 17, 2007
Ms. COLLINS (for herself, Mr. CASEY, Mr. BOND, Ms. CANTWELL, Mr. ROBERTS, and Mr. REED) introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to protect Medicare beneficiaries' access to home health services 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.
SEC. 2. PROTECTING ACCESS TO MEDICARE HOME HEALTH SERVICES.
(a) In General- Section 1895(b)(3) of the Social Security Act (42 U.S.C. 1395fff(b)(3)) is amended--
(1) in subparagraph (B)(iv), by adding at the end the following: `Such adjustment shall not be made with respect to home health services for payment in 2008 and in making such an adjustment with respect to home health services for payment in a subsequent year, the Secretary shall evaluate changes in case mix using standards developed by the Secretary consistent with the processes described in subparagraph (D)(i) and taking into account the criteria described in subparagraph (D)(ii).'; and
(2) by adding at the end the following new subparagraph:
`(D) PROCESSES AND CRITERIA FOR EVALUATING CHANGES IN CASE MIX- For purposes of subparagraph (B)(iv)--
`(i) PROCESSES- The processes described in this clause are the following:
`(I) In developing standards referred to in such subparagraph, the Secretary shall convene a Technical Advisory Group consisting of stakeholders, including individuals and organizations representing the interests of Medicare beneficiaries, the National Association for Home Care & Hospice, and the Visiting Nurse Associations of America, 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.
`(II) If the Secretary engages an outside contractor to participate in the evaluation of case mix changes described in subclause (I), the Secretary shall only utilize a contractor that has not previously participated in the design and establishment of the case mix adjustment factors under subparagraph (B).
`(III) 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 that 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.
`(IV) The Secretary shall establish the standards referred to in subclause (I) by regulation.
`(V) 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 subclause (I), regarding the standards at the time of notice of such standards.
`(ii) CRITERIA- The criteria described in this clause are the following:
`(I) The impact of changes in the program under this title that may affect the characteristics of individuals receiving home health services.
`(II) The impact of changes in the provision of health care services by providers of services other than home health agencies.
`(III) Distinctions in the characteristics of individuals initiating home health services from the community and institutional care settings.
`(IV) 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 impact.
`(V) Any other factors determined appropriate by the Secretary in consultation with the Technical Advisory Group under clause (i)(I).'.
(b) Voiding of Proposed Case Mix Adjustment- The Secretary of Health and Human Services shall not take any action to implement or otherwise carry out provisions contained in the final rule published on August 29, 2007, on pages 49762-49945 of volume 72 of the Federal Register, insofar as such provisions propose to make a case mix adjustment to the standardized payment amounts under the prospective payment system for home health services under section 1895 of the Social Security Act (42 U.S.C. 1395fff) to account for changes in coding that were not related to an underlying change in patient health status. The Secretary shall republish any rates specified in such rule to take into account the application of the previous sentence. The Secretary shall only institute an adjustment under subparagraph (B)(iv) of such section in compliance with subparagraph (D) of such section, as added by subsection (a)(2).
U.S. Congress - Text of S.2181 as Introduced in Senate Home Health Care Access Protection Act of 2007
