H.R.4495 - Medicare Beneficiary Access to Home Care Act of 1998105th Congress (1997-1998)
Summary: H.R.4495 — 105th Congress (1997-1998)
Introduced in House (08/06/1998)
Medicare Beneficiary Access to Home Care Act of 1998 - Amends title XVIII (Medicare) of the Social Security Act (SSA), as amended by the Balanced Budget Act of 1997 (BBA '97), with respect to the computation formula of the interim system of limited payments for services provided by home health agencies. Repeals the current interim system, retroactive to the enactment of BBA '97. Mandates a new interim system of limits for cost reporting periods beginning on or after October 1, 1998, with a revised formula that includes: (1) retroactive restoration of the per visit cost limit to 112 percent of the mean of costs; (2) an agency-specific, annual per beneficiary limitation equal to the sum of certain base and outlier amounts, based generally on the standardized average cost per unduplicated patient in FY 1994; and (3) application of a wage index based on the locality of the agency.
Amends BBA '97 to revise the mandatory reduction in cost and per beneficiary limits in the event that the Secretary of Health and Human Services does not establish the prospective payment system (PPS) for home health services. Replaces the current 15 percent reduction in such limits with a percentage reduction sufficient to assure that total expenditures for home health services benefits in each of FY 1999 through 2002 do not exceed the original Congressional Budget Office spending targets for such fiscal years.
Amends SSA title XVIII to direct the Secretary to restore periodic interim payments for home health services.
Directs the Secretary to continue the home health per episode prospective payment demonstration project under the Omnibus Budget Reconciliation Act of 1987 until the PPS for home health services is established and implemented under Medicare.
Revises surety bond requirements for home health agencies under the Medicare program and the Medicaid program of SSA title XIX to: (1) specify a surety bond against fraudulent or abusive activities; and (2) reduce the amount of such bond from a minimum of $50,000 to $25,000.
Amends SSA title XVIII to require home health agencies to have fraud and abuse compliance programs as a condition of their Medicare participation.