,i #aacth ,,congress #b;d ,session ,h4 ,r4 #eaaj ,,in ,,the ,,house ,,of ,,representatives ,july #ae1 #bjad ,mr4 ,walden 7for himself1 ,mr4 ,price of ,georgia1 ,mrs4 ,ellmers1 ,mr4 ,mc,kinley1 ,mr4 ,latham1 ,mr4 ,duffy1 ,mrs4 ,mc,morris ,rodgers1 ,mr4 ,graves of ,missouri1 ,mr4 ,boustany1 ,mr4 ,paulsen1 ,mr4 ,thompson of ,pennsylvania1 ,mr4 ,young of ,alaska1 and ,mr4 ,gardner7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 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 repeal rebasing of payments for home health services1 as required under the ,patient ,protection and ,affordable ,care ,act1 and to replace such rebasing with a ,medicare home health value-based purchasing program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,securing ,access ,via ,excellence for ,medicare ,home ,health ,act of #bjad or the ,,save ,medicare ,home ,health ,act of #bjad4 #b4 ,repeal of ,medicare home health rebasing reduction provided under ,,ppaca and detailed analysis of such reduction 7a7 ,repeal of rebasing reduction and codification of ,,cy #bjad payment adjustment 7#a7 ,repeal ,section #ahie7;b77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77#c77;,a77 is amended by striking clause 7iii74 7#b7 ,codification ,such section1 as amended by paragraph 7#a71 is further amended by adding at the end the following new clause3 7iii7 ,codification of ,,cy #bjad payment adjustment ,the amount 7or amounts7 that would otherwise be applicable under clause 7i77,,iii7 for #bjae and subsequent years shall be determined taking into account the #c4e percentage point reduction effective for #bjad pursuant to the rule for home health prospective payment system rate update for calendar year #bjad 7promulgated on ,december #b1 #bjac1 #gh ,federal ,register #gbbef74 4 7b7 ,detailed analysis of rebasing reduction 7#a7 ,in general ,the ,secretary of ,health and ,human ,services shall conduct a detailed analysis of the rebasing reduction in ,medicare payments for home health services promulgated under the rule for home health prospective payment system rate update for calendar year #bjad 7promulgated on ,december #b1 #bjac1 #gh ,federal ,register #gbbef71 pursuant to the ,regulatory ,flexibility ,act1 ,executive ,order #acefc1 section #caca7;a7 of the ,patient ,protection and ,affordable ,care ,act1 and other specified factors4 ,such analysis shall include an assessment of at least the following factors3 7,a7 ,the age1 poverty level1 gender1 rural residence1 ethnic or racial minority1 and infirmity of ,medicare beneficiaries receiving home health services in comparison to other ,medicare beneficiaries4 7,b7 ,the number1 gender1 and geographic distribution of professional ,medicare home health caregivers4 7,c7 ,the number and location of home health agencies that have closed1 consolidated1 or been acquired since the rebasing reduction was implemented4 7,d7 ,the number and location of professional home health caregiver jobs that have been lost since the rebasing reduction was implemented4 7#b7 ,report ,not later than ,february #a1 #bjae1 the ,secretary shall submit to ,congress a report that contains findings regarding the analysis conducted under paragraph 7#a71 including the ,secretary's assessment of the factors specified in such paragraph4 #c4 ,establishment of home health value-based purchasing 7,,vbp7 program 7a7 ,readmission measures ,section #ahie of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7 is amended by adding at the end the following new subsection3 7f7 ,post-,hospital home health services readmission measure 7#a7 ,readmission measure ,not later than ,january #a1 #bjaf1 the ,secretary shall specify a home health all-cause all-condition hospital unplanned readmission measure 7or any successor to such a measure7 for readmissions 7for any cause7 to a hospital for an individual who is entitled to benefits under part ,a 7or enrolled under part ,b7 and who is receiving post-hospital home health services4 7#b7 ,resource use measure ,not later than ,january #a1 #bjag1 the ,secretary shall specify a measure that is the measure specified under paragraph 7#a71 risk-adjusted for potentially preventable readmissions to a hospital for an individual described in such paragraph4 7#c7 ,development ,the measures specified under paragraphs 7#a7 and 7#b7 shall be developed through a formal process that is based on input from a group of multiple stakeholders consisting of at least senior advocates1 ,medicare beneficiaries1 caregivers1 and home health physicians1 nurses1 therapists1 and operators of home health agencies4 7#d7 ,quarterly feedback reports to home health agencies ,beginning ,january #a1 #bjag1 and every quarter thereafter1 the ,secretary shall provide confidential feedback to home health agencies on their performance with respect to such measures4 7#e7 ,public reporting on performance 7,a7 ,in general ,subject to subparagraphs 7,b7 and 7,c71 the ,secretary shall establish procedures for making public on the ,medicare ,home ,health ,compare website 7or successor to such website7 the performance of home health agencies with respect to a measure specified under paragraph 7#a7 and a measure specified under paragraph 7#b74 7,b7 ,opportunity to review ,the procedures under subparagraph 7,a7 shall ensure that a home health agency has the opportunity to review and submit corrections to the information that is to be made public with respect to such agency before such information is made public4 7,c7 ,timing ,such procedures shall provide that the information described in subparagraph 7,a7 is first made publicly available beginning no later than ,january #a1 #bjah4 4 7b7 ,value-,based purchasing program for home health agencies ,section #ahie of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff71 as amended by subsection 7a71 is further amended by adding at the end the following new subsection3 7g7 ,application of value-,based purchasing program 7#a7 ,establishment 7,a7 ,in general ,subject to the succeeding provisions of this subsection1 the ,secretary shall establish a home health agency value-based purchasing program 7in this subsection referred to as the ,,hha ,,vbp ,program7 under which value-based incentive payments are made in a year to home health agencies4 7,b7 ,program to begin in #bjai ,the ,,hha ,,vbp ,program shall apply to payments for episodes of home health services beginning on or after ,january #a1 #bjai4 7#b7 ,application of measures -- 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary shall apply the measure specified under subsection 7f77#b7 for purposes of the ,,hha ,,vbp ,program4 7,b7 ,replacement ,if the ,secretary determines that the application of such measure is not practicable and should be delayed and the ,secretary notifies the ,committee on ,finance of the ,senate and the ,committees on ,ways and ,means and ,energy and ,commerce of the ,house of ,representatives of the reasons for such delay in advance of implementing such delay1 the ,secretary may delay the application of such measure for a period of up to #a year4 ,for the period of any such delay1 the measure specified under subsection 7f77#a7 shall apply for purposes of the ,,hha ,,vbp ,program instead of the measure specified under subsection 7f77#b74 7#c7 ,performance standards 7,a7 ,establishment ,the ,secretary shall establish performance standards with respect to the measure applied under paragraph 7#b7 for a performance period for a year4 7,b7 ,higher of achievement and improvement ,the performance standards established under subparagraph 7,a7 shall include levels of achievement and improvement4 ,in calculating the ,,hha performance score under paragraph 7#d71 the ,secretary shall use the higher of either improvement or achievement4 7,c7 ,timing ,the ,secretary shall establish and announce the performance standards established under subparagraph 7,a7 not later than #fj days before the beginning of the performance period for the year involved4 7#d7 ,,hha performance score 7,a7 ,in general ,the ,secretary shall develop by regulation a methodology for assessing the total performance of each home health agency based on performance standards established under paragraph 7#c7 with respect to the measure applied under paragraph 7#b74 ,using such methodology1 the ,secretary shall provide for an assessment 7in this subsection referred to as the ,,hha performance score7 for each home health agency for each such performance period4 7,b7 ,ranking of hha performance scores ,the ,secretary shall1 for the performance period for each year1 rank the ,,hha performance scores determined under subparagraph 7,a7 from low to high4 7#e7 ,budget neutral withholding ,the ,secretary shall withhold from the payment rates made for each year 7during the period beginning with #bjai and ending with #bjbd7 for home health services under this section such withholding percentage as is necessary so that the enactment of the ,securing ,access ,via ,excellence for ,medicare ,home ,health ,act of #bjad is estimated not to result in any net change in payments made for such services under this title4 7#f7 ,value-based incentive payment percentage ,the ,secretary shall provide for a distribution of a portion of the amounts withheld under paragraph 7#e7 for performance payments to home health agencies in a manner so as to ensure that-- 7,a7 the distribution 7expressed as a percentage of such withheld amounts7 is based on each agency's ,,hha performance ranking under paragraph 7#d77;,b7 for the performance period for the year involved2 7,b7 the application of all such percentages in such year results in an appropriate distribution of value-based incentive payments under this subsection such that-- 7i7 home health agencies with the highest rankings under paragraph 7#d77;,b7 receive the highest value-based incentive payment amounts under this subsection2 7ii7 home health agencies with the lowest rankings under paragraph 7#d77;,b7 receive the lowest value-based incentive payment amounts under this subsection2 and 7iii7 in the case of home health agencies in the lowest #dj percent of the ranking under paragraph 7#d77;,b71 the payment rate under this subsection for services furnished by such facility during such year shall be less than the payment rate for such services for such year that would otherwise apply without application of this subsection2 and 7,c7 the total amount of value-based incentive payments under this subsection for all home health agencies in such year shall be greater than or equal to #ej percent1 but not greater than #gj percent1 of the total amount of the payments withheld for such year under paragraph 7#e71 as estimated by the ,secretary4 7#g7 ,announcement of result of adjustments ,under the ,,hha ,,vbp program1 the ,secretary shall1 not later than #fj days before a year involved1 inform each home health agency of the adjustments to payments to the agency for services furnished by the agency during the year under this subsection4 7#h7 ,no effect in subsequent year ,the value-based payment adjustments under this subsection shall only apply with respect to the year involved1 and the ,secretary shall not take into account such adjustment in making payments to a home health agency under this section in a subsequent year4 7#i7 ,funding for program management ,the ,secretary shall provide for the one-time transfer from the ,federal ,supplementary ,medical ,insurance ,trust ,fund established under section #ahda to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account of-- 7,a7 #b1jjj1jjj for purposes of subsection 7f72 and 7,b7 #aj1jjj1jjj for purposes of implementing this subsection4 ,such funds shall remain available until expended4 4 7c7 ,med,p,a,c ,study ,not later than ,june #cj1 #bjba1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a report that reviews the progress of the home health value-based purchasing program established under section #ahie7;g7 of the ,social ,security ,act1 as added by subsection 7b71 and makes recommendations1 as appropriate1 on any improvements that should be made to such program4 ,for purposes of the previous sentence1 the ,medicare ,payment ,advisory ,commission shall consider any unintended consequences with respect to such home health agency value-based purchasing program and any potential adjustments to the readmission measure specified under section #ahie7;f7 of such ,act1 as added by subsection 7a71 for purposes of determining the effect of the socio-economic status of a beneficiary under the ,medicare program under title ,,xviii of the ,social ,security ,act on the performance score of a home health agency provided under section #ahie7;g77#d7 of such ,act1 as added by subsection 7b74