Section 10315

SEC. 10315. REVISIONS TO HOME HEALTH CARE PROVISIONS.

[a] Rebasing- Section 1895[b][3][A][iii] of the Social Security Act, as added by section 3131, is amended--

[1] in the clause heading, by striking '2013' and inserting '2014';

[2] in subclause [I], by striking '2013' and inserting '2014'; and

[3] in subclause [II], by striking '2016' and inserting '2017'.

[b] Revision of Home Health Study and Report- Section 3131[d] is amended to read as follows:

'[d] Study and Report on the Development of Home Health Payment Revisions in Order to Ensure Access to Care and Payment for Severity of Illness-

'[1] IN GENERAL- The Secretary of Health and Human Services [in this section referred to as the 'Secretary'] shall conduct a study on home health agency costs involved with providing ongoing access to care to low-income Medicare beneficiaries or beneficiaries in medically underserved areas, and in treating beneficiaries with varying levels of severity of illness. In conducting the study, the Secretary may analyze items such as the following:

'[A] Methods to potentially revise the home health prospective payment system under section 1895 of the Social Security Act [42 U.S.C. 1395fff] to account for costs related to patient severity of illness or to improving beneficiary access to care, such as--

'[i] payment adjustments for services that may involve additional or fewer resources;

'[ii] changes to reflect resources involved with providing home health services to low-income Medicare beneficiaries or Medicare beneficiaries residing in medically underserved areas;

'[iii] ways outlier payments might be revised to reflect costs of treating Medicare beneficiaries with high levels of severity of illness; and

'[iv] other issues determined appropriate by the Secretary.

'[B] Operational issues involved with potential implementation of potential revisions to the home health payment system, including impacts for both home health agencies and administrative and systems issues for the Centers for Medicare & Medicaid Services, and any possible payment vulnerabilities associated with implementing potential revisions.

'[C] Whether additional research might be needed.

'[D] Other items determined appropriate by the Secretary.

'[2] CONSIDERATIONS- In conducting the study under paragraph [1], the Secretary may consider whether patient severity of illness and access to care could be measured by factors, such as--

'[A] population density and relative patient access to care;

'[B] variations in service costs for providing care to individuals who are dually eligible under the Medicare and Medicaid programs;

'[C] the presence of severe or chronic diseases, which might be measured by multiple, discontinuous home health episodes;

'[D] poverty status, such as evidenced by the receipt of Supplemental Security Income under title XVI of the Social Security Act; and

'[E] other factors determined appropriate by the Secretary.

'[3] REPORT- Not later than March 1, 2014, the Secretary shall submit to Congress a report on the study conducted under paragraph [1], together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

'[4] CONSULTATIONS- In conducting the study under paragraph [1], the Secretary shall consult with appropriate stakeholders, such as groups representing home health agencies and groups representing Medicare beneficiaries.

'[5] MEDICARE DEMONSTRATION PROJECT BASED ON THE RESULTS OF THE STUDY-

'[A] IN GENERAL- Subject to subparagraph [D], taking into account the results of the study conducted under paragraph [1], the Secretary may, as determined appropriate, provide for a demonstration project to test whether making payment adjustments for home health services under the Medicare program would substantially improve access to care for patients with high severity levels of illness or for low-income or underserved Medicare beneficiaries.

'[B] WAIVING BUDGET NEUTRALITY- The Secretary shall not reduce the standard prospective payment amount [or amounts] under section 1895 of the Social Security Act [42 U.S.C. 1395fff] applicable to home health services furnished during a period to offset any increase in payments during such period resulting from the application of the payment adjustments under subparagraph [A].

'[C] NO EFFECT ON SUBSEQUENT PERIODS- A payment adjustment resulting from the application of subparagraph [A] for a period--

'[i] shall not apply to payments for home health services under title XVIII after such period; and

'[ii] shall not be taken into account in calculating the payment amounts applicable for such services after such period.

'[D] DURATION- If the Secretary determines it appropriate to conduct the demonstration project under this subsection, the Secretary shall conduct the project for a four year period beginning not later than January 1, 2015.

'[E] FUNDING- The Secretary shall provide for the transfer from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act [42 U.S.C. 1395i] and the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of such Act [42 U.S.C. 1395t], in such proportion as the Secretary determines appropriate, of $500,000,000 for the period of fiscal years 2015 through 2018. Such funds shall be made available for the study described in paragraph [1] and the design, implementation and evaluation of the demonstration described in this paragraph. Amounts available under this subparagraph shall be available until expended.

'[F] EVALUATION AND REPORT- If the Secretary determines it appropriate to conduct the demonstration project under this subsection, the Secretary shall--

'[i] provide for an evaluation of the project; and

'[ii] submit to Congress, by a date specified by the Secretary, a report on the project.

'[G] ADMINISTRATION- Chapter 35 of title 44, United States Code, shall not apply with respect to this subsection.'.