INCREASE IN PER BENEFICIARY LIMITS AND PER VISIT PAYMENT LIMITS FOR PAYMENT FOR HOME HEALTH SERVICES.

SEC. 5101. INCREASE IN PER BENEFICIARY LIMITS AND PER VISIT PAYMENT LIMITS FOR PAYMENT FOR HOME HEALTH SERVICES. (a) Increase in Per Beneficiary Limits.—Section 1861(v)(1)(L) of the Social Security Act (42 U.S.C. 1395x(v)(1)(L)) is amended— (1) in the first sentence of clause (v), by inserting “subject to clause (viii)(I),” before “the Secretary”; (2) in clause (vi)(I), by inserting “subject to clauses (viii)(II) and (viii)(III)” after “fiscal year 1994”; and (3) by adding at the end the following new clause: “(viii)(I) In the case of a provider with a 12-month cost reporting period ending in fiscal year 1994, if the limit imposed under clause (v) (determined without regard to this subclause) for a cost reporting period beginning during or after fiscal year 1999 is less than the median described in clause (vi)(I) (but determined as if any reference in clause (v) to ‘98 percent’ were a reference to ‘100 percent’), the limit otherwise imposed under clause (v) for such provider and period shall be increased by 1/3 of such difference. “(II) Subject to subclause (IV), for new providers and those providers without a 12-month cost reporting period ending in fiscal year 1994, but for which the first cost reporting period begins before fiscal year 1999, for cost reporting periods beginning during or after fiscal year 1999, the per beneficiary limitation described in clause (vi)(I) shall be equal to the median described in such clause (determined as if any reference in clause (v) to ‘98 percent’ were a reference to ‘100 percent’). “(III) Subject to subclause (IV), in the case of a new provider for which the first cost reporting period begins during or after fiscal year 1999, the limitation applied under clause (vi)(I) (but only with respect to such provider) shall be equal to 75 percent of the median described in clause (vi)(I). “(IV) In the case of a new provider or a provider without a 12-month cost reporting period ending in fiscal year 1994, subclause (II) shall apply, instead of subclause (III), to a home health agency which filed an application for home health agency provider status under this title before September 15, 1998, or which was approved as a branch of its parent agency before such date and becomes a subunit of the parent agency or a separate agency on or after such date. “(V) Each of the amounts specified in subclauses (I) through (III) are such amounts as adjusted under clause (iii) to reflect variations in wages among different areas.”.112 STAT. 2681–914 (b) Revision of Per Visit Limits.—Section 1861(v)(1)(L)(i) of such Act (42 U.S.C. 1395x(v)(1)(L)(i)) is amended— (1) in subclause (III), by striking “or”; (2) in subclause (IV)— (A) by inserting “and before October 1, 1998,” after “October 1, 1997,”; and (B) by striking the period at the end and inserting “, or”; and (3) by adding at the end the following new subclause: “(V) October 1, 1998, 106 percent of such median.”. (c) One-Year Delay in 15 Percent Reduction in Payment Limits; Change in Timing of Implementation of Prospective Payment System.— (1) Prospective payment system.—Section 1895 of such Act (42 U.S.C. 1395fff) is amended— (A) in subsection (a), by striking “for cost reporting periods beginning on or after October 1, 1999” and inserting “for portions of cost reporting periods occurring on or after October 1, 2000”; and (B) in subsection (b)(3)— (i) in subparagraph (A)(i), by striking “fiscal year 2000” and inserting “fiscal year 2001”; (ii) in subparagraph (A)(ii), by striking “September 30, 1999” and inserting “September 30, 2000”; and (iii) in subparagraph (B)(i), by striking “fiscal year 2001” and inserting “fiscal year 2002”. (2) Change in effective date.—Section 4603(d) of the Balanced Budget Act of 1997 (42 U.S.C. 1395fff note) is amended by striking “cost reporting periods beginning on or after October 1, 1999” and inserting “portions of cost reporting periods occurring on or after October 1, 2000”. (3) Contingency reduction.—Section 4603(e) of the Balanced Budget Act of 1997 (42 U.S.C. 1395fff note) is amended— (A) by striking “cost reporting periods described in subsection (d), for such cost reporting periods” and inserting “portions of cost reporting periods described in subsection (d), for such portions”; and (B) by striking “September 30, 1999” and inserting “September 30, 2000”. (d) Change in Home Health Market Basket Increase.— (1) Interim payment system.—Section 1861(v)(1)(L) of the Social Security Act (42 U.S.C. 1395x(v)(1)(L)), as amended by subsection (a)(3), is amended by adding at the end the following: “(ix) Notwithstanding any other provision of this subparagraph, in updating any limit under this subparagraph by a home health market basket index for cost reporting periods beginning during each of fiscal years 2000, 2001, 2002, and 2003, the update otherwise provided shall be reduced by 1.1 percentage points.”. (2) Prospective payment system.—Section 1895(b)(3)(B) of such Act (42 U.S.C. 1395fff(b)(3)(B)) is amended— (A) in clause (i), by striking “home health market basket percentage increase” and inserting “home health applicable increase percentage (as defined in clause (ii))”; (B) by redesignating clause (ii) as clause (iii); and (C) by inserting after clause (i) the following: “(ii) Home health applicable increase percentage.—For purposes of this subparagraph, the term 112 STAT. 2681–915‘home health applicable increase percentage’ means, with respect to— “(I) fiscal year 2002 or 2003, the home health market basket percentage increase (as defined in clause (iii)) minus 1.1 percentage points; or “(II) any subsequent fiscal year, the home health market basket percentage increase.”. (e) Exclusion of Additional Part B Costs From Determination of Part B Monthly Premium.—Section 1839 of such Act (42 U.S.C. 1395r) is amended— (1) in subsection (a)(3), by inserting “(except as provided in subsection (g))” after “year that”; and (2) by adding at the end the following new subsection: “(g) In estimating the benefits and administrative costs which will be payable from the Federal Supplementary Medical Insurance Trust Fund for a year for purposes of determining the monthly premium rate under subsection (a)(3), the Secretary shall exclude an estimate of any benefits and administrative costs attributable to the application of section 1861(v)(1)(L)(viii) or to the establishment under section 1861(v)(1)(L)(i)(V) of a per visit limit at 106 percent of the median (instead of 105 percent of the median), but only to the extent payment for home health services under this title is not being made under section 1895 (relating to prospective payment for home health services).”. (f) Reports on Summary of Research Conducted by the Secretary on the Prospective Payment System.—By not later than January 1, 1999, the Secretary of Health and Human Services shall submit to Congress a report on the following matters: (1) Research.—A description of any research paid for by the Secretary on the development of a prospective payment system for home health services furnished under the medicare program under title XVIII of the Social Security Act, and a summary of the results of such research. (2) Schedule for Implementation of System.—The Secretary’s schedule for the implementation of the prospective payment system for home health services under section 1895 of the Social Security Act (42 U.S.C. 1395fff). (g) MedPAC Reports.— (1) Review of secretary’s report.—Not later than 60 days after the date the Secretary of Health and Human Services submits to Congress the report under subsection (f), the Medicare Payment Advisory Commission (established under section 1805 of the Social Security Act (42 U.S.C. 1395b–6)) shall submit to Congress a report describing the Commission’s analysis of the Secretary’s report, and shall include the Commission’s recommendations with respect to the matters contained in such report. (2) Annual report.—The Commission shall include in its annual report to Congress for June 1999 an analysis of whether changes in law made by the Balanced Budget Act of 1997, as modified by the amendments made by this section, with respect to payments for home health services furnished under the medicare program under title XVIII of the Social Security Act, impede access to such services by individuals entitled to benefits under such program. (h) GAO Audit of Research Expenditures.—The Comptroller General of the United States shall conduct an audit of sums 112 STAT. 2681–916obligated or expended by the Health Care Financing Administration for the research described in subsection (f)(1), and of the data, reports, proposals, or other information provided by such research. (i) Prompt Implementation.— (1) In general.—The Secretary of Health and Human Services shall promptly issue (without regard to chapter 8 of title 5, United States Code) such regulations or program memoranda as may be necessary to effect the amendments made by this section for cost reporting periods beginning during fiscal year 1999. (2) Use of payment amounts and limits from published tables.— (A) Per beneficiary limits.—In effecting the amendments made by subsection (a) for cost reporting periods beginning in fiscal year 1999, the “median” referred to in section 1861(v)(1)(L)(vi)(I) of the Social Security Act for such periods shall be the national standardized per beneficiary limitation specified in Table 3C published in the Federal Register on August 11, 1998 (63 FR 42926) and the “standardized regional average of such costs” referred to in section 1861(v)(1)(L)(v)(I) of such Act for a census division shall be the sum of the labor and nonlabor components of the standardized per beneficiary limitation for that census division specified in Table 3B published in the Federal Register on that date (63 FR 42926) (or in Table 3D as so published with respect to Puerto Rico and Guam), and adjusted to reflect variations in wages among different geographic areas as specified in Tables 4a and 4b published in the Federal Register on that date (63 FR 42926–42933). (B) Per visit limits.—In effecting the amendments made by subsection (b) for cost reporting periods beginning in fiscal year 1999, the limits determined under section 1861(v)(1)(L)(i)(V) of such Act for cost reporting periods beginning during such fiscal year shall be equal to the per visit limits as specified in Table 3A published in the Federal Register on August 11, 1998 (63 FR 42925) and as subsequently corrected, multiplied by 106/105, and adjusted to reflect variations in wages among different geographic areas as specified in Tables 4a and 4b published in the Federal Register on August 11, 1998 (63 FR 42926–42933).