Home Health Payment Innovation Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 2573 To amend title XVIII of the Social Security Act to improve home health payment reforms under the Medicare program. IN THE HOUSE OF REPRESENTATIVES MAY 8, 2019 Ms. SEWELL of Alabama (for herself, Mr. BUCHANAN, Mr. ABRAHAM, Ms. KUSTER of New Hampshire, Mr. LARSON of Connecticut, Mr. MARCH- ANT, Mr. GRAVES of Louisiana, Mr. ARRINGTON, Mr. THORNBERRY, Mr. PANETTA, and Mr. DESJARLAIS) 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 de- termined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 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 VerDate Sep 11 2014 03:30 May 15, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2573.IH H2573 SSpencer on DSKBBXCHB2PROD with BILLS 2 •HR 2573 IH SEC. 2. IMPROVEMENTS TO MEDICARE INNOVATIONS AND 1 MANAGED CARE RELATED TO HOME HEALTH 2 SERVICES. 3 (a) EXPANDED WAIVERS IN SHARED SAVINGS PRO- 4 GRAMS.—Section 1899(f) of the Social Security Act (42 5 U.S.C. 395jjj(f)), is amended by adding at the end the 6 following: ‘‘Beginning not later than January 1, 2020, the 7 Secretary shall include a waiver of the ‘confined to his 8 home’ requirement under sections 1814(a)(2)(C) and 9 1835(a)(2)(A) in one or more programs under this sec- 10 tion.’’. 11 (b) FLEXIBILITY IN MEDICARE ADVANTAGE 12 PLANS.—Section 1852 of the Social Security Act (42 13 U.S.C. 1395ww–2) is amended by adding at the end the 14 following: 15 ‘‘(o) FLEXIBILITY IF PROVIDING HOME HEALTH 16 SERVICES.—Notwithstanding any other provision of law, 17 any MA organization shall be permitted to waive the ‘con- 18 fined to his home’ requirement in the home health services 19 benefit when the organization determines it is in the best 20 interest of the enrollee.’’. 21 SEC. 3. IMPROVEMENTS TO HOME HEALTH PAYMENT RE- 22 FORMS UNDER MEDICARE. 23 (a) APPLICATION OF BUDGET NEUTRALITY.—Sec- 24 tion 1895(b)(3) of the Social Security Act (42 U.S.C. 25 1395fff(b)(3)), as amended by section 51001(a)(2) of the 26 VerDate Sep 11 2014 03:30 May 15, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2573.IH H2573 SSpencer on DSKBBXCHB2PROD with BILLS 3 •HR 2573 IH Bipartisan Budget Act of 2018 (Public Law 115–123), 1 is amended— 2 (1) in subparagraph (A)(iv), in the fourth sen- 3 tence— 4 (A) by striking ‘‘shall make’’ and inserting 5 ‘‘shall not make’’; and 6 (B) by striking ‘‘and shall provide a de- 7 scription’’ and all that follows through the pe- 8 riod and inserting a period; and 9 (2) in subparagraph (D)— 10 (A) in the subparagraph heading, by strik- 11 ing ‘‘ASSUMPTIONS’’ and inserting ‘‘EVIDENCE’’; 12 (B) in clause (i)— 13 (i) by striking ‘‘differences between 14 assumed’’ and all that follows through 15 ‘‘and actual’’; 16 (ii) by inserting ‘‘attributable to the 17 implementation of paragraphs (2)(B) and 18 (4)(B)’’ after ‘‘behavior changes’’; and 19 (iii) by adding at the end the fol- 20 lowing: ‘‘The Secretary shall publish the 21 determination under this clause with re- 22 spect to an applicable year, including a de- 23 scription of the evidence used to make such 24 determination, in the notice and comment 25 VerDate Sep 11 2014 03:30 May 15, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2573.IH H2573 SSpencer on DSKBBXCHB2PROD with BILLS 4 •HR 2573 IH rulemaking to update the prospective pay- 1 ment system under this subsection for such 2 year. For purposes of the preceding sen- 3 tence, the term ‘evidence’ means the most 4 recent data after January 1, 2020, that re- 5 flects the difference between real changes 6 in case mix and behavioral changes relat- 7 ing to implementation of the provisions of 8 and amendments made by section 51001 of 9 the Bipartisan Budget Act of 2018 (Public 10 Law 115–123).’’; 11 (C) in clause (ii), by inserting ‘‘attrib- 12 utable to the implementation of paragraphs 13 (2)(B) and (4)(B)’’ after ‘‘expenditures’’; and 14 (D) in clause (iii)— 15 (i) by adding ‘‘attributable to the im- 16 plementation of paragraphs (2)(B) and 17 (4)(B)’’ after ‘‘expenditures’’; and 18 (ii) by adding at the end the fol- 19 lowing: ‘‘If such a temporary increase or 20 decrease does not exceed 2.00 percent in 21 any given year, the Secretary shall apply 22 the entire increase or decrease in the next 23 calendar year payment update. In the case 24 where such a temporary increase or de- 25 VerDate Sep 11 2014 03:30 May 15, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2573.IH H2573 SSpencer on DSKBBXCHB2PROD with BILLS 5 •HR 2573 IH crease exceeds 2.00 percent, the Secretary 1 shall phase in the temporary increase or 2 decrease in equal amounts not to exceed 3 2.00 percent in any given year through the 4 respective calendar year payment updates. 5 Notwithstanding the preceding sentence, 6 the Secretary shall complete any such 7 phase-in adjustment no later than 2029 8 and shall have the authority, after 2025, to 9 waive the phase-in requirement as nec- 10 essary to achieve budget neutrality by 11 2029. Prior to implementing such phase-in 12 adjustments after 2025, the Secretary 13 shall first receive certification from the Of- 14 fice of the Actuary of the Centers for 15 Medicare & Medicaid Services that any 16 such adjustments are appropriate.’’. 17 (b) EFFECTIVE DATE.—The amendments made by 18 this section shall take effect as if included in the enact- 19 ment of such section 51001(a)(2). 20 Æ VerDate Sep 11 2014 03:30 May 15, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H2573.IH H2573 SSpencer on DSKBBXCHB2PROD with BILLS