S 659

112th CONGRESS
1st Session

S. 659

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

March 29, 2011

Ms. COLLINS (for herself and Ms. CANTWELL) 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.

    This Act may be cited as the `Home Health Care Access Protection Act of 2011'.

SEC. 2. PROTECTING ACCESS TO MEDICARE HOME HEALTH SERVICES.

    Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C. 1395fff(b)(3)(B)) 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 ADJUSTMENT FOR CASE MIX CHANGES FOR 2012 AND SUBSEQUENT YEARS-

            `(I) IN GENERAL- For 2012 and each subsequent year, subject to subclause (IV), any adjustment under clause (iv) shall only be made using standards established by the Secretary consistent with the processes described in subclause (II) and taking into account the considerations described in subclause (III).

            `(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) The Secretary shall convene a Technical Advisory Group to advise the Secretary concerning the establishment of standards under subclause (I) 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 composed of stakeholders, including an equal number of individuals and organizations representing the interests of Medicare beneficiaries, the National Association for Home Care and Hospice, the Visiting Nurse Associations of America, health care academia, and health care professionals. Members shall not have an existing contractual relationship with the Secretary at the time of their appointment to the Technical Advisory Group. The Secretary shall provide the Technical Advisory Group an opportunity to review and comment on any proposed rulemaking or final determination of the Secretary with respect to such standards prior to the issuance of the proposed rulemaking or making of the final 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 an outside contractor that has not previously participated in the design and establishment of the case mix adjustment factors under paragraph (4)(B).

`(cc) If the Secretary determines that any increase in case mix relates to changes in the volume or nature of home health services provided, the Secretary shall evaluate that increase through the 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 such standards by regulation.

`(ee) The Secretary shall make available to the public all data, reports, and supporting materials, including any comments by the Technical Advisory Group under item (aa), regarding the establishment of such standards at the time of the publication of the notice of the proposed regulation.

            `(III) CONSIDERATIONS- For purposes of subclause (I), the considerations described in this subclause are the following:

`(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 home health services by providers of services and suppliers other than home health agencies.

`(cc) Distinctions in the characteristics of individuals initiating home health services from community and institutional care settings.

`(dd) Whether any changes in coding resulted in a change in aggregate payments under this subsection during the fiscal year or year and disregarding changes in coding that did not result in such a change in aggregate payments.

`(ee) Any other factors determined appropriate by the Secretary, in consultation with the Technical Advisory Group under subclause (II)(aa).

            `(IV) EXCEPTION FOR CERTAIN ADJUSTMENTS FOR 2012- This clause shall not apply to any adjustment under clause (iv) that is scheduled in a final rule for 2012 as of January 1, 2011.'.

END