,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #dfbe  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #i1 #bjad ,mr4   
,hall introduc$ ! foll[+ bill2 :i* 0    
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
susp5d ! application ( ! rebas+ (       
,m$ic>e home heal? prospective paym5t   
am\nts1 & = o!r purposes4  #a4 ,%ort    
title ,?is ,act may be cit$ z ! ,m$ic>e 
,home ,heal? ,rebas+ ,relief &          
,reassessm5t ,act4  #b4 ,relief &       
reassessm5t ( ! rebas+ ( ,m$ic>e home   
heal? prospective paym5t am\nts  7a7    
,susp5sion ( rebas+ ,section            
#ahie7;b77#c77;,a77iii7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acie;fff7b77#c77;,a77iii77 is am5d$--  
7#a7 9 subclause 7,i71 9 ! fir/ s5t5ce1 

by /rik+ subclause 7,,ii7 & ins]t+      
subclauses 7,,ii7 & 7,,iii72  7#b7 9    
subclause 7,,ii71 9 ! fir/ s5t5ce1 by   
/rik+ ,! ,secret>y & ins]t+ ,subject to 
subclause 7,,iii71 ! ,secret>y2 &  7#c7 
by add+ at ! end ! foll[+ new subclause3
  7,,iii7 ,special rule ,subclauses 7,i7
 & 7,,ii7 %all n apply = ! #ab-mon?     
p]iod beg9n+ on ! date ( ! enactm5t (   
?is subclause4 ,= p]iods beg9n+ aft] !  
p]iod describ$ 9 ! previ\s s5t5ce1 !    
,secret>y %all apply su* subclauses z if
 ! previ\s s5t5ce _h n be5 enact$4  4   
7b7 ,revision ( home heal? outli]       
adju/m5t ,section #ahie7;b77#e77;,a7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;fff7b77#e77;,a77 is am5d$1 9 !    
second s5t5ce1 by ins]t+ 7or1 9 ! case (
 ea* ( ! ye>s #bjae ?r\gh #bjbc1 #b4be  
p]c5t7 aft] #b4e p]c5t4  7c7 ,/udy &    
report  7#a7 ,/udy  7,a7 ,9 g5]al ,!    
,secret>y ( ,heal? & ,human ,s]vices1 9 
consultation ) repres5tatives ( ,m$ic>e 
home heal? ag5cies & b5efici>ies1 %all  
conduct a /udy on alt]native me?ods =   

det]m9+ ! appropriate adju/m5t "u       
section #ahie7;b77#c77;,a77iii7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acie7;b77#c77;,a77iii771 includ+ me?ods
 (f]$ by /akehold]s4 ,su* /udy %all     
include an analysis ( ea* ( ! foll[+3   
7i7 ,! project$ impact on ,m$ic>e       
b5efici>y access to c>e dur+ ea* ( #bjad
 ?r\gh #bjag ( apply+ section           
#ahie7;b77#c7 dur+ ea* ( su* ye>s )\t   
application ( subp>agraph 7,a77iii7 (   
su* section1 comp>$ to ! project$ impact
 on su* access dur+ ea* ( su* ye>s (    
apply+ su* section dur+ ea* ( su* ye>s )
 application ( su* subp>agraph4  7ii7 ,!
 numb] & %>e ( home heal? ag5cies t are 
project$ to exp]i5ce negative ,m$ic>e   
m>g9s by #bjag1 includ+ ! location1     
size1 & type ( su* ag5cies4  7iii7 ,)   
respect to home heal? ag5cies describ$ 9
 clause 7ii7--  7,i7 ! total numb]1     
av]age age1 av]age income1 & av]age     
numb] ( activities ( daily liv+ ( !     
,m$ic>e b5efici>ies su* ag5cies s]ve2   
7,,ii7 ! numb] ( /aff su* ag5cies       

employ2  7,,iii7 ! numb] & location (   
c\nties 9 :i* su* ag5cies s]ve z ! sole 
provid] ( ,m$ic>e home heal? s]vices2 & 
7,,iv7 to ! ext5t practicable1 ! pay]   
mix ( su* ag5cies4  7iv7 ,! impact ( !  
adju/m5t on small home heal? ag5cies1 z 
def9$ by ! ,unit$ ,/ates ,small ,bus9ess
 ,adm9i/ration small bus9ess size /&>ds1
 consi/5t ) ! pr9ciples ( ! ,regulatory 
,flexibility ,act1 :i* requires ,f$]al  
ag5cies1 includ+ ! ,dep>tm5t ( ,heal? & 
,human ,s]vices1 to fully consid] dur+ !
 rulemak+ process ! economic impact (   
regulatory provisions1 z well z less    
burd5some regulatory alt]natives1 to    
small entities4  7v7 ,any o!r areas     
det]m9$ appropriate by ! ,secret>y4     
7,b7 ,requirem5t = alt]native me?ods &  
o!r consid]ations ,= purposes ( !       
analysis "u subp>agraph 7,a7--  7i7 !   
alt]native me?ods describ$ 9 su*        
subp>agraph %all cov] ea* ( ! ye>s 9 :i*
 ! rebas+ adju/m5t "u su* section       
#ahie7;b77#c77;,a77iii7 is to be appli$2
 &  7ii7 ! ,secret>y %all include a     

cumulative analysis ( o!r ,m$ic>e home  
heal? reimbursem5t r$uctions e/abli%$ by
 /atute or regulation1 consi/5t ) !     
requirem5ts ( ,executive ,ord] #acefc4  
7#b7 ,report ,n lat] ?an #f mon?s aft] !
 date ( ! enactm5t ( ?is ,act1 !        
,secret>y ( ,heal? & ,human ,s]vices    
%all submit to ,congress a report on !  
/udy conduct$ "u p>agraph 7#a71 toge!r )
 su* recomm5dations z ! ,secret>y       
det]m9es appropriate bas$ on ! f9d+s (  
su* /udy4 ,su* report %all include--    
7,a7 a det]m9ation by ! ,secret>y z to  
:e!r1 z a result ( ! f9d+s ( su* /udy1 !
 ,secret>y int5ds to use ! au?ority "u  
section #ahga ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;hh7 to modify !   
adju/m5t describ$ 9 p>agraph 7#a77;,a7 &
 ! ext5t ( any su* modification2 &  7,b7
 9 ! case ! ,secret>y det]m9es n to use 
su* au?ority1 ! rationale = su*         
det]m9ation4