Home Health Care Access Protection Act of 2010 - Amends title XVIII (Medicare) of the Social Security Act, as amended by the Patient Protection and Affordable Care Act, with respect to the prospective payment system (PPS) for home health services and adjustments to it for case mix changes.
Requires for years beginning with 2011 that any evaluation of case mix changes and any such adjustment be made using standards developed consistent with specified processes, taking certain criteria into account.
Directs the Secretary to convene a Technical Advisory Group to advise on the development of such standards.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5803 Introduced in House (IH)]
111th CONGRESS
2d Session
H. R. 5803
To amend title XVIII of the Social Security Act to protect Medicare
beneficiaries' access to home health services under the Medicare
Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 21, 2010
Mr. McGovern (for himself and Mr. Jones) 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 determined 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 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 2010''.
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)), as amended by section 3401(e) of the Patient
Protection and Affordable Care Act, 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 case mix changes
for 2011 and later.--
``(I) In general.--The adjustment
under clause (iv) shall only be made
for years beginning with 2011 using
standards developed by the Secretary
consistent with the processes described
in subclause (II) taking into account
the criteria 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) In developing
standards referred to in such
subclause, the Secretary shall
convene a Technical Advisory
Group consisting of
stakeholders, including
individuals and organizations
representing the interests of
Medicare beneficiaries, the
home health community, health
care academia, and health care
professionals, in equal numbers
from each and limited to
parties without an existing
contractual relationship with
the Secretary, to advise the
Secretary concerning the
establishment of such standards
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 given the
opportunity to review and
comment on any proposed
rulemaking or final
determination by the Secretary
on such standards prior to such
rulemaking or 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 a
contractor that has not
previously participated in the
design and establishment of the
case mix adjustment factors
under this subparagraph.
``(cc) If the Secretary
determines that any increase in
case mix relates to changes in
the volume or nature of
services provided to home
health services patients, the
Secretary shall evaluate such
increase through 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 the standards
referred to in item (aa) by
regulation.
``(ee) With respect to
establishment of such
standards, the Secretary shall
make public all data, reports,
and supporting materials,
including any comments by the
Technical Advisory Group
pursuant to item (aa),
regarding the standards at the
time of notice of such
standards.
``(III) Criteria.--The criteria
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
health care services by
providers of services other
than home health agencies.
``(cc) Distinctions in the
characteristics of individuals
initiating home health services
from the community and
institutional care settings.
``(dd) Whether any changes
in coding resulted in a change
in expenditures overall
annually and disregarding
changes in coding that do not
have an overall expenditure
impact.
``(ee) Any other factors
determined appropriate by the
Secretary in consultation with
the Technical Advisory Group
under subclause (II)(aa).''.
<all>
Introduced in House
Introduced in House
Referred to House Ways and Means
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to House Energy and Commerce
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