,i #aaeth ,,congress #ast ,session ,h4 ,r4 #ciib ,,in ,,the ,,house ,,of ,,representatives ,october #f1 #bjag,mrs4 ,noem 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 delay application of1 transition to1 and limit savings for the home health groupings model under the ,medicare home health prospective payment system1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,rural ,home ,health ,extension and ,regulatory ,relief ,act4 #b4 ,delaying application of1 transitioning to1 and limiting savings for home health groupings model under ,medicare home health prospective payment system2 home health rural add-on 7a7 ,delayed implementation of home health groupings model with limit on savings and with transition 7#a7 ,in general ,section #ahie7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77 is amended by inserting at the end the following new paragraph3 7#g7 ,implementation of home health groupings model 7,a7 ,use of home health groupings model with delayed implementation ,for purposes of calculating standard prospective payment amounts under the prospective payment system under this subsection with respect to home health units of service furnished on or after ,january #a1 #bjbj1 and subject to the succeeding subparagraphs of this paragraph1 the ,secretary shall apply the home health groupings model including use of a #cj-;day unit of payment1 as described in the proposed rule entitled ,medicare and ,medicaid ,programs2 ,,cy #bjah ,home ,health ,prospective ,payment ,system ,rate ,update and ,proposed ,,cy #bjai ,case-,mix ,adjustment ,methodology ,refinements2 ,home ,health ,value-,based ,purchasing ,model2 and ,home ,health ,quality ,reporting ,requirements 7#hb ,fed4 ,reg4 #cebid through #ceccb 7,july #bh1 #bjag7 7herein referred to as the #bjah ,home ,health ,proposed ,rule77 and as such model may subsequently be revised through notice and comment rulemaking4 7,b7 ,calculation of budget neutral payment amounts 7i7 ,in general ,the ,secretary shall1 subject to subparagraph 7,f71 calculate payment amounts under this subsection with respect to home health #cj-;day periods of care furnished in #bjbj in a manner such that the estimated aggregate amount of expenditures under the prospective payment system under this subsection with application of this paragraph is equal to the estimated aggregate amount of expenditures under this subsection without application of this paragraph4 7ii7 ,exclusion of adjustments from calculation ,adjustments under paragraph 7#c7 7including adjustments for case mix changes under clause 7iv7 of such paragraph7 and paragraph 7#e7 and subparagraphs 7,e7 and 7,f7 shall not be included in the calculation under clause 7i74 7,c7 ,limiting savings compared to the #bjah home health proposed rule ,in order to reduce the aggregate amount of savings under the home health groupings model compared to the estimated impacts in the #bjah ,home ,health ,proposed ,rule1 after calculating amounts in subparagraph 7,b71 the ,secretary shall reduce such #bjbj amounts by #c4g percent4 7,d7 ,standard prospective payment amounts for #bjbj and subsequent years 7i7 ,standard prospective payment amounts ,the standard prospective payment amounts for home health #cj-;day periods of care beginning with #bjbj shall be the amounts reduced in subparagraph 7,c7 subject to clauses 7iv7 and 7v7 of subparagraph 7,f74 7ii7 ,application of adjustments ,adjustments described in subparagraph 7,b77ii7 7other than the adjustment described in subparagraph 7,e77 shall be applied to such standard prospective payment amounts4 7,e7 ,transitional adjustments to home health groupings model ,in order to provide for a transition to the home health groupings model1 the ,secretary shall1 after application of adjustments described in subparagraph 7,d77ii71 increase payment amounts under clause 7iii7 as follows3 7i7 ,for #bjbj1 the increase shall be #a4e percent4 7ii7 ,for #bjba1 the increase shall be #a4j percent4 7iii7 ,for #bjbb1 the increase shall be #j4e percent4 7,f7 ,provider behavior assumptions and reconciliation 7i7 ,assumptions ,in calculating amounts under subparagraph 7,b77i71 the ,secretary shall make assumptions about provider behavioral change that could occur as a result of implementation of the home health groupings model such as for changes in the number of service units and changes in diagnosis codes billed4 7ii7 ,description of assumptions ,the ,secretary shall provide a description of the assumptions made under clause 7i7 in the notice and comment rulemaking used to implement this paragraph4 7iii7 ,reconciliation ,not later than #bjbe1 and in subsequent years as appropriate1 the ,secretary shall determine the impact of differences between actual and assumed behavior on estimated aggregate expenditures under this subsection4 7iv7 ,permanent adjustments ,the ,secretary shall1 at a time and in a manner determined appropriate1 provide for one or more permanent increases or decreases to the standard prospective payment amounts for applicable years1 on a prospective basis1 to account for the determination under clause 7iii74 7v7 ,temporary adjustments for retrospective behavior ,the ,secretary shall1 at a time and in a manner determined appropriate1 provide for one or more temporary increases or decreases to the standard prospective payment amounts for applicable years1 on a prospective basis1 to account for the determination under clause 7iii7 with respect to years before the adjustment in clause 7iv74 7vi7 ,other behavior ,the ,secretary shall1 at a time and in a manner determined appropriate1 apply permanent and temporary adjustments to adjust for increases in estimated aggregate expenditures as a result of behavior responses not described in clause 7ii74 7,g7 ,continued application of provisions ,except as described in this paragraph1 the provisions of this section shall continue to apply4 4 7#b7 ,conforming amendment ,paragraph 7#b7 of section #ahie7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77#b77 is amended by striking ,in and inserting ,subject to paragraph 7#g77;,a71 in4 7b7 ,extension of home health rural add-,on ,section #dba of the ,medicare ,prescription ,drug1 ,improvement1 and ,modernization ,act of #bjjc 7,public ,law #ajh-agc2 #aag ,stat4 #bbhc71 as amended by section #ebja7;b7 of the ,deficit ,reduction ,act of #bjje 7,public ,law #aji-aga2 #abj ,stat4 #df71 section #caca7;c7 of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh2 #abd ,stat4 #dbh71 and section #baj of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj2 #abi ,stat4 #hg71 is amended by striking ,january #a1 #bjah each place it appears and inserting ,january #a1 #bjbc4 7c7 ,reports 7#a7 ,interim report ,not later than ,march #ae1 #bjbb1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress an interim report on the modifications made by section #ahie7;b77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;fff7b77#g771 as added by subsection 7a71 and any unintended consequences including-- 7,a7 behavioral changes that may occur due to lower reimbursement for ,medication ,management1 ,training and ,assessment2 7,b7 behavioral changes that may occur due to higher reimbursement following hospitalizations2 7,c7 use of statistically derived1 versus actual1 payment weights2 7,d7 questionable encounters2 7,e7 use of both primary and secondary diagnosis codes for episode assignment2 and 7,f7 reducing reimbursement of behavioral health episodes1 compared to the ,home ,health ,resource ,group model4 7#b7 ,final report ,not later than ,march #ae1 #bjbf1 ,med,p,a,c1 the ,medicare ,payment ,advisory ,commission shall submit to ,congress a final report on such modifications and any such consequences4