MODIFICATION OF PART A HOME HEALTH BENEFIT FOR INDIVIDUALS ENROLLED UNDER PART B.

SEC. 4611. MODIFICATION OF PART A HOME HEALTH BENEFIT FOR INDIVIDUALS ENROLLED UNDER PART B. (a) In General.—Section 1812 (42 U.S.C. 1395d) is amended— (1) in subsection (a)(3), by striking “home health services” and inserting “for individuals not enrolled in part B, home health services, and for individuals so enrolled, post-institutional home health services furnished during a home health spell of illness for up to 100 visits during such spell of illness”; and (2) in subsection (b), by adding after and below paragraph (3) the following: “Payment under this part for post-institutional home health services furnished an individual during a home health spell of illness may not be made for such services beginning after such services have been furnished for a total of 100 visits such spell.”. (b) Post-Institutional Home Health Services Defined.—Section 1861 (42 U.S.C. 1395x), as amended by sections 4103(a), 4104(a), 4105(a), 4106(a), and 4454, is amended by adding at the end the following: “Post-Institutional Home Health Services; Home Health Spell of Illness “(tt)(1) The term ‘post-institutional home health services’ means home health services furnished to an individual— “(A) after discharge from a hospital or rural primary care hospital in which the individual was an inpatient for not less than 3 consecutive days before such discharge if such home health services were initiated within 14 days after the date of such discharge; or “(B) after discharge from a skilled nursing facility in which the individual was provided post-hospital extended care services if such home health services were initiated within 14 days after the date of such discharge. “(2) The term ‘home health spell of illness’ with respect to any individual means a period of consecutive days— “(A) beginning with the first day (not included in a previous home health spell of illness) (i) on which such individual is 111 STAT. 473furnished post-institutional home health services, and (ii) which occurs in a month for which the individual is entitled to benefits under part A, and “(B) ending with the close of the first period of 60 consecutive days thereafter on each of which the individual is neither an inpatient of a hospital or rural primary care hospital nor an inpatient of a facility described in section 1819(a)(1) or subsection (y)(1) nor provided home health services.”. (c) Maintaining Appeal Rights for Home Health Services.—Section 1869(b)(2)(B) (42 U.S.C. 1395f(b)(2)(B)) is amended by inserting “(or $100 in the case of home health services)” after “$500”. (d) Maintaining Seamless Administration Through Fiscal Intermediaries.—Section 1842(b)(2) (42 U.S.C. 1395u(b)(2)) is amended by adding at the end the following: “(E) With respect to the payment of claims for home health services under this part that, but for the amendments made by section 4611 of the Balanced Budget Act of 1997, would be payable under part A instead of under this part, the Secretary shall continue administration of such claims through fiscal intermediaries under section 1816.”. (e) Transition.— (1) In general.—Notwithstanding any provision of title XVIII of the Social Security Act, the Secretary of Health and Human Services shall establish a transition for the aggregate amount of expenditures that are transferred from part A, to part B, of title XVIII of the Social Security Act, as a result of the amendments made by this section, during each of the years during the period beginning with 1998 and ending with 2002 according to this subsection. Under the transition for each such year, the Secretary shall effect such transfer, between the trust funds under such parts, as will result in only the proportion (specified in paragraph (2)) of such aggregate expenditures for the year being transferred from such part A to such part B. (2) Proportion specified.—The proportion specified in this paragraph for— (A) 1998 is ⅙, (B) 1999 is ⅓, (C) 2000 is ½, (D) 2001 is ⅔, and (E) 2002 is ⅚. (3) Application in establishing monthly premiums for 1998 through 2003.— (A) For purposes only of computing the monthly premium under section 1839 of the Social Security Act (42 U.S.C. 1395r), the monthly actuarial rate for enrollees age 65 and over shall be computed as though any reference in paragraph (1) of this subsection to 2002 were a reference to 2003 and as if the following proportions were substituted for the proportions specified in paragraph (2): (i) For 1998, ⅟7. (ii) For 1999, 2/7. (iii) For 2000, 3/7. (iv) For 2001, 4/7. (v) For 2002, 5/7. 111 STAT. 474 (vi) For 2003, 6/7. (B) No impact on government contribution.—Subparagraph (A) does not apply in determining the amount of the Government contribution under section 1844 of the Social Security Act (42 U.S.C. 1395w). (f) Effective Date.—The amendments made by this section apply to services furnished on or after January 1, 1998. For purpose of applying such amendments, any home health spell of illness that began, but not did not end, before such date shall be considered to have begun as of such date.