Home Health Payment Innovation Act of 2019

II 116TH CONGRESS 1ST SESSION S. 433 To amend title XVIII of the Social Security Act to improve home health payment reforms under the Medicare program. IN THE SENATE OF THE UNITED STATES FEBRUARY 11, 2019 Ms. COLLINS (for herself, Ms. STABENOW, Mr. KENNEDY, Mr. JONES, Mr. CASSIDY, Mr. PAUL, and Mrs. SHAHEEN) 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 improve home health payment reforms under the Medicare program. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Home Health Payment 4 Innovation Act of 2019’’. 5 SEC. 2. IMPROVEMENTS TO MEDICARE INNOVATIONS AND 6 MANAGED CARE RELATED TO HOME HEALTH 7 SERVICES. 8 (a) EXPANDED WAIVERS IN SHARED SAVINGS PRO- 9 GRAMS.—Section 1899(f) of the Social Security Act (42 10 VerDate Sep 11 2014 02:07 Feb 23, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S433.IS S433 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 433 IS U.S.C. 395jjj(f)), is amended by adding at the end the 1 following: ‘‘Beginning not later than January 1, 2020, the 2 Secretary shall include a waiver of the ‘confined to his 3 home’ requirement under sections 1814(a)(2)(C) and 4 1835(a)(2)(A) in one or more programs under this sec- 5 tion.’’. 6 (b) FLEXIBILITY IN MEDICARE ADVANTAGE 7 PLANS.—Section 1852 of the Social Security Act (42 8 U.S.C. 1395ww–2) is amended by adding at the end the 9 following: 10 ‘‘(o) FLEXIBILITY IF PROVIDING HOME HEALTH 11 SERVICES.—Notwithstanding any other provision of law, 12 any MA organization shall be permitted to waive the ‘con- 13 fined to his home’ requirement in the home health services 14 benefit when the organization determines it is in the best 15 interest of the enrollee.’’. 16 SEC. 3. IMPROVEMENTS TO HOME HEALTH PAYMENT RE- 17 FORMS UNDER MEDICARE. 18 (a) APPLICATION OF BUDGET NEUTRALITY.—Sec- 19 tion 1895(b)(3) of the Social Security Act (42 U.S.C. 20 1395fff(b)(3)), as amended by section 51001(a)(2) of the 21 Bipartisan Budget Act of 2018 (Public Law 115–123), 22 is amended— 23 (1) in subparagraph (A)(iv), in the fourth sen- 24 tence— 25 VerDate Sep 11 2014 02:07 Feb 23, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S433.IS S433 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 433 IS (A) by striking ‘‘shall make’’ and inserting 1 ‘‘shall not make’’; and 2 (B) by striking ‘‘and shall provide a de- 3 scription’’ and all that follows through the pe- 4 riod and inserting a period; and 5 (2) in subparagraph (D)— 6 (A) in the subparagraph heading, by strik- 7 ing ‘‘ASSUMPTIONS’’ and inserting ‘‘EVIDENCE’’; 8 (B) in clause (i)— 9 (i) by striking ‘‘differences between 10 assumed’’ and all that follows through 11 ‘‘and actual’’; 12 (ii) by inserting ‘‘attributable to the 13 implementation of paragraphs (2)(B) and 14 (4)(B)’’ after ‘‘behavior changes’’; and 15 (iii) by adding at the end the fol- 16 lowing: ‘‘The Secretary shall publish the 17 determination under this clause with re- 18 spect to an applicable year, including a de- 19 scription of the evidence used to make such 20 determination, in the notice and comment 21 rulemaking to update the prospective pay- 22 ment system under this subsection for such 23 year. For purposes of the preceding sen- 24 tence, the term ‘evidence’ means the most 25 VerDate Sep 11 2014 02:07 Feb 23, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S433.IS S433 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 433 IS recent data after January 1, 2020, that re- 1 flects the difference between real changes 2 in case mix and behavioral changes relat- 3 ing to implementation of the provisions of 4 and amendments made by section 51001 of 5 the Bipartisan Budget Act of 2018 (Public 6 Law 115–123).’’; 7 (C) in clause (ii), by inserting ‘‘attrib- 8 utable to the implementation of paragraphs 9 (2)(B) and (4)(B)’’ after ‘‘expenditures’’; and 10 (D) in clause (iii)— 11 (i) by adding ‘‘attributable to the im- 12 plementation of paragraphs (2)(B) and 13 (4)(B)’’ after ‘‘expenditures’’; and 14 (ii) by adding at the end the fol- 15 lowing: ‘‘If such a temporary increase or 16 decrease does not exceed 2.00 percent in 17 any given year, the Secretary shall apply 18 the entire increase or decrease in the next 19 calendar year payment update. In the case 20 where such a temporary increase or de- 21 crease exceeds 2.00, the Secretary shall 22 phase in the temporary increase or de- 23 crease in equal amounts not to exceed 2.00 24 percent in any given year through the re- 25 VerDate Sep 11 2014 02:07 Feb 23, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S433.IS S433 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 433 IS spective calendar year payment updates. 1 Notwithstanding the preceding sentence, 2 the Secretary shall complete any such 3 phase-in adjustment no later than 2029 4 and shall have the authority, after 2025, to 5 waive the phase-in requirement as nec- 6 essary to achieve budget neutrality by 7 2029. Prior to implementing such phase-in 8 adjustments after 2025, the Secretary 9 shall first receive certification from the Of- 10 fice of the Actuary of the Centers for 11 Medicare & Medicaid Services that any 12 such adjustments are appropriate.’’. 13 (b) EFFECTIVE DATE.—The amendments made by 14 this section shall take effect as if included in the enact- 15 ment of such section 51001(a)(2). 16 Æ VerDate Sep 11 2014 02:07 Feb 23, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S433.IS S433 pamtmann on DSKBFK8HB2PROD with BILLS