,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #begc  ,,in ,,the ,,house ,,of  
,,representatives  ,may #h1 #bjai,ms4   
,sewell of ,alabama 7for herself1 ,mr4  
,buchanan1 ,mr4 ,abraham1 ,ms4 ,kuster  
of ,new ,hampshire1 ,mr4 ,larson of     
,connecticut1 ,mr4 ,marchant1 ,mr4      
,graves of ,louisiana1 ,mr4 ,arrington1 
,mr4 ,thornberry1 ,mr4 ,panetta1 and    
,mr4 ,des,jarlais7 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 improve   
home health payment reforms under the   
,medicare program4  #a4 ,short title    
,this ,act may be cited as the ,home    
,health ,payment ,innovation ,act of    
#bjai4  #b4 ,improvements to ,medicare  

innovations and managed care related to 
home health services  7a7 ,expanded     
waivers in shared savings programs      
,section #ahii7;f7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#cie;jjj7f771 is amended by adding at   
the end the following3 ,beginning not   
later than ,january #a1 #bjbj1 the      
,secretary shall include a waiver of the
 confined to his home requirement under 
sections #ahad7;a77#b77;,c7 and         
#ahce7;a77#b77;,a7 in one or more       
programs under this section44  7b7      
,flexibility in ,medicare advantage     
plans ,section #aheb of the ,social     
,security ,act 7#db ,u4,s4,c4           
#acieww-#b7 is amended by adding at the 
end the following3  7o7 ,flexibility if 
providing home health services          
,notwithstanding any other provision of 
law1 any ,,ma organization shall be     
permitted to waive the confined to his  
home requirement in the home health     
services benefit when the organization  
determines it is in the best interest of

 the enrollee4  4  #c4 ,improvements to 
home health payment reforms under       
,medicare  7a7 ,application of budget   
neutrality ,section #ahie7;b77#c7 of the
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;fff7b77#c771 as amended by section
 #eajja7;a77#b7 of the ,bipartisan      
,budget ,act of #bjah 7,public ,law     
#aae-abc71 is amended--  7#a7 in        
subparagraph 7,a77iv71 in the fourth    
sentence-- 7,a7 by striking shall make  
and inserting shall not make2 and  7,b7 
by striking and shall provide a         
description and all that follows through
 the period and inserting a period2 and 
7#b7 in subparagraph 7,d7--  7,a7 in the
 subparagraph heading1 by striking      
assumptions and inserting evidence2     
7,b7 in clause 7i7--  7i7 by striking   
differences between assumed and all that
 follows through and actual2  7ii7 by   
inserting attributable to the           
implementation of paragraphs 7#b77;,b7  
and 7#d77;,b7 after behavior changes2   
and  7iii7 by adding at the end the     

following3 ,the ,secretary shall publish
 the determination under this clause    
with respect to an applicable year1     
including a description of the evidence 
used to make such determination1 in the 
notice and comment rulemaking to update 
the prospective payment system under    
this subsection for such year4 ,for     
purposes of the preceding sentence1 the 
term evidence means the most recent data
 after ,january #a1 #bjbj1 that reflects
 the difference between real changes in 
case mix and behavioral changes relating
 to implementation of the provisions of 
and amendments made by section #eajja of
 the ,bipartisan ,budget ,act of #bjah  
7,public ,law #aae-abc742  7,c7 in      
clause 7ii71 by inserting attributable  
to the implementation of paragraphs     
7#b77;,b7 and 7#d77;,b7 after           
expenditures2 and  7,d7 in clause       
7iii7--  7i7 by adding attributable to  
the implementation of paragraphs        
7#b77;,b7 and 7#d77;,b7 after           
expenditures2 and  7ii7 by adding at the

 end the following3 ,if such a temporary
 increase or decrease does not exceed   
#b4jj percent in any given year1 the    
,secretary shall apply the entire       
increase or decrease in the next        
calendar year payment update4 ,in the   
case where such a temporary increase or 
decrease exceeds #b4jj percent1 the     
,secretary shall phase in the temporary 
increase or decrease in equal amounts   
not to exceed #b4jj percent in any given
 year through the respective calendar   
year payment updates4 ,notwithstanding  
the preceding sentence1 the ,secretary  
shall complete any such phase-in        
adjustment no later than #bjbi and shall
 have the authority1 after #bjbe1 to    
waive the phase-in requirement as       
necessary to achieve budget neutrality  
by #bjbi4 ,prior to implementing such   
phase-in adjustments after #bjbe1 the   
,secretary shall first receive          
certification from the ,office of the   
,actuary of the ,centers for ,medicare  
,medicaid ,services that any such       

adjustments are appropriate44  7b7      
,effective date ,the amendments made by 
this section shall take effect as if    
included in the enactment of such       
section #eajja7;a77#b74