Sec. 51001. HOME HEALTH PAYMENT REFORM
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## SEC. 51001 HOME HEALTH PAYMENT REFORM ###
(a)Budget Neutral Transition to a 30-day Unit of Payment for Home Health Services Section 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)) is amended— ####
(1)in paragraph (2)— #####
(A)by striking “ payment.—In defining ” and inserting “ payment.— ” > > ##### “(A) In general > > In defining” > ; and #####
(B)by adding at the end the following new subparagraph: > > ##### “(B) 30-day unit of service > > For purposes of implementing the prospective payment system with respect to home health units of service furnished during a year beginning with 2020, the Secretary shall apply a 30-day unit of service as the unit of service applied under this paragraph.” > ; ####
(2)in paragraph (3)— #####
(A)in subparagraph (A), by adding at the end the following new clause: > > ###### “(iv) Budget neutrality for 2020 > > With respect to payments for home health units of service furnished that end during the 12-month period beginning January 1, 2020, the Secretary shall calculate a standard prospective payment amount (or amounts) for 30-day units of service (as described in paragraph (2)(B)) for the prospective payment system under this subsection. Such standard prospective payment amount (or amounts) shall be calculated in a manner such that the estimated aggregate amount of expenditures under the system during such period with application of paragraph (2)(B) is equal to the estimated aggregate amount of expenditures that otherwise would have been made under the system during such period if paragraph (2)(B) had not been enacted. The previous sentence shall be applied before (and not affect the application of) paragraph (3)(B). In calculating such amount (or amounts), the Secretary shall make assumptions about behavior changes that could occur as a result of the implementation of paragraph (2)(B) and the case-mix adjustment factors established under paragraph (4)(B) and shall provide a description of such assumptions in the notice and comment rulemaking used to implement this clause.” > ; and #####
(B)by adding at the end the following new subparagraph: > > ##### “(D) Behavior assumptions and adjustments > > > ###### “(i) In general > > The Secretary shall annually determine the impact of differences between assumed behavior changes (as described in paragraph (3)(A)(iv)) and actual behavior changes on estimated aggregate expenditures under this subsection with respect to years beginning with 2020 and ending with 2026. > > > ###### “(ii) Permanent adjustments > > The Secretary shall, at a time and in a manner determined appropriate, through notice and comment rulemaking, provide for one or more permanent increases or decreases to the standard prospective payment amount (or amounts) for applicable years, on a prospective basis, to offset for such increases or decreases in estimated aggregate expenditures (as determined under clause (i)). > > > ###### “(iii) Temporary adjustments for retrospective behavior > > The Secretary shall, at a time and in a manner determined appropriate, through notice and comment rulemaking, provide for one or more temporary increases or decreases to the payment amount for a unit of home health services (as determined under paragraph (4)) for applicable years, on a prospective basis, to offset for such increases or decreases in estimated aggregate expenditures (as determined under clause (i)). Such a temporary increase or decrease shall apply only with respect to the year for which such temporary increase or decrease is made, and the Secretary shall not take into account such a temporary increase or decrease in computing such amount under this subsection for a subsequent year.” > ; and ####
(3)in paragraph (4)(B)— #####
(A)by striking “ Factors.—The Secretary ” and inserting > “Factors.— > > > ###### “(i) In general > > The Secretary” > ; and #####
(B)by adding at the end the following new clause: > > ###### “(ii) Treatment of therapy thresholds > > For 2020 and subsequent years, the Secretary shall eliminate the use of therapy thresholds (established by the Secretary) in case mix adjustment factors established under clause
(i)for calculating payments under the prospective payment system under this subsection.” > . ###
(b)Technical Expert Panel ####
(1)In general During the period beginning on January 1, 2018, and ending on December 31, 2018, the Secretary of Health and Human Services shall hold at least one session of a technical expert panel, the participants of which shall include home health providers, patient representatives, and other relevant stakeholders. The technical expert panel shall identify and prioritize recommendations with respect to the prospective payment system for home health services under section 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)), on the following: #####
(A)The Home Health Groupings Model, as described in the proposed rule “Medicare and Medicaid Programs; CY 2018 Home Health Prospective Payment System Rate Update and Proposed CY 2019 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; and Home Health Quality Reporting Requirements” (82 Fed. Reg. 35294 through 35332 (July 28, 2017)). #####
(B)Alternative case-mix models to the Home Health Groupings Model that were submitted during 2017 as comments in response to proposed rule making, including patient-focused factors that consider the risks of hospitalization and readmission to a hospital, improvement or maintenance of functionality of individuals to increase the capacity for self-care, quality of care, and resource utilization. ####
(2)Inapplicability of faca The provisions of the Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the technical expert panel under paragraph (1). ####
(3)Report Not later than April 1, 2019, the Secretary of Health and Human Services shall submit to the Committee on Ways and Means and the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report on the recommendations of such panel described in such paragraph. ####
(4)Notice and comment rulemaking Not later than December 31, 2019, the Secretary of Health and Human Services shall pursue notice and comment rulemaking on a case-mix system with respect to the prospective payment system for home health services under section 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)). ###
(c)Reports ####
(1)Interim report Not later than March 15, 2022, the Medicare Payment Advisory Commission shall submit to Congress an interim report on the application of a 30-day unit of service as the unit of service applied under section 1895(b)(2) of the Social Security Act (42 U.S.C. 1395fff(b)(2)), as amended by subsection (a), including an analysis of the level of payments provided to home health agencies as compared to the cost of delivering home health services, and any unintended consequences, including with respect to behavioral changes and quality. ####
(2)Final report Not later than March 15, 2026, such Commission shall submit to Congress a final report on such application and any such consequences.
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- 82 FR 35294
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