Sec. 2104. Extension of home health rural add-on

807 words·~4 min read·/bill/115/hr/1892/eah/section-2104

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Section 421 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ( Public Law 108–173 ; 117 Stat. 2283; 42 U.S.C. 1395fff note), as amended by section 5201(b) of the Deficit Reduction Act of 2005 ( Public Law 109–171 ; 120 Stat. 46), section 3131(c) of the Patient Protection and Affordable Care Act ( Public Law 111–148 ; 124 Stat. 428), and section 210 of the Medicare Access and CHIP Reauthorization Act of 2015 ( Public Law 114–10 ; 129 Stat. 151) is amended— in subsection (a), by striking January 1, 2018 and inserting January 1, 2019 each place it appears; by redesignating subsections

(b)and

(c)as subsections

(c)and (d), respectively; in each of subsections

(c)and (d), as so redesignated, by striking subsection

(a)and inserting subsection

(a)or

(b); and by inserting after subsection

(a)the following new subsection: The Secretary shall increase the payment amount otherwise made under such section 1895 for home health services furnished in a county (or equivalent area) in a rural area (as defined in such section 1886(d)(2)(D)) that, as determined by the Secretary— is in the highest quartile of all counties (or equivalent areas) based on the number of Medicare home health episodes furnished per 100 individuals who are entitled to, or enrolled for, benefits under part A of title XVIII of the Social Security Act or enrolled for benefits under part B of such title (but not enrolled in a plan under part C of such title)— in the case of episodes and visits ending during 2019, by 1.5 percent; and in the case of episodes and visits ending during 2020, by 0.5 percent; has a population density of 6 individuals or fewer per square mile of land area and is not described in subparagraph (A)— in the case of episodes and visits ending during 2019, by 4 percent; in the case of episodes and visits ending during 2020, by 3 percent; in the case of episodes and visits ending during 2021, by 2 percent; and in the case of episodes and visits ending during 2022, by 1 percent; and is not described in either subparagraph

(A)or (B)— in the case of episodes and visits ending during 2019, by 3 percent; in the case of episodes and visits ending during 2020, by 2 percent; and in the case of episodes and visits ending during 2021, by 1 percent. For purposes of this subsection, the determination by the Secretary as to which subparagraph of paragraph

(1)applies to a county (or equivalent area) shall be made a single time and shall apply for the duration of the period to which this subsection applies. In determining which counties (or equivalent areas) are in the highest quartile under paragraph (1)(A), the following rules shall apply: The Secretary shall use data from 2015. The Secretary shall exclude data from the territories (and the territories shall not be described in such paragraph). The Secretary may exclude data from counties (or equivalent areas) in rural areas with a low volume of home health episodes (and if data is so excluded with respect to a county (or equivalent area), such county (or equivalent area) shall not be described in such paragraph). In determining population density under paragraph (1)(B), the Secretary shall use data from the 2010 decennial Census. There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of determinations under paragraph (1). . Section 1895(c) of the Social Security Act ( 42 U.S.C. 1395fff(c) ) is amended— in paragraph (1), by striking and at the end; in paragraph (2), by striking the period at the end and inserting ; and ; and by adding at the end the following new paragraph: in the case of home health services furnished on or after January 1, 2019, the claim contains the code for the county (or equivalent area) in which the home health service was furnished. . The Office of the Inspector General shall submit to Congress, not later than January 1, 2020, and annually thereafter through January 1, 2024, a report containing— an analysis of payments made under section 1895 of the Social Security Act ( 42 U.S.C. 1395fff ) increased under section 421 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ( Public Law 108–173 ; 117 Stat. 2283; 42 U.S.C. 1395fff note), as amended by section 5201(b) of the Deficit Reduction Act of 2005 ( Public Law 109–171 ; 120 Stat. 46), section 3131(c) of the Patient Protection and Affordable Care Act ( Public Law 111–148 ; 124 Stat. 428), section 210 of the Medicare Access and CHIP Reauthorization Act of 2015 ( Public Law 114–10 ; 129 Stat. 151), and subsection (a); and a recommendation on whether such payments should continue to be made based on county data.

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