II
110th CONGRESS
1st Session
S. 1605
IN THE SENATE OF THE UNITED STATES
June 13, 2007
Mr. Conrad (for himself, Mr. Roberts, Mr. Harkin, Mr. Salazar, Mr. Domenici, Mr. Bingaman, Mr. Smith, Mr. Nelson of Nebraska, Ms. Snowe, Mrs. Murray, Mr. Thune, Mr. Dorgan, Ms. Collins, Mr. Johnson, Mr. Enzi, and Mrs. Lincoln) introduced the following bill; which was read twice and referred to the Committee on Finance
A BILL
To amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program, and for other purposes.
Short title; table of contents
Short title
This Act may be cited as the Craig Thomas Rural Hospital and Provider Equity Act of
2007
.
Table of Contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals.
Sec. 3. Revision of the Medicare hold harmless provision under the prospective payment system for hospital outpatient department (HOPD) services.
Sec. 4. Improvement of definition of low-volume hospital for purposes of the Medicare inpatient hospital payment adjustment.
Sec. 5. Extension of Medicare wage index reclassifications for certain hospitals.
Sec. 6. Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas.
Sec. 7. Critical access hospital improvements.
Sec. 8. Capital infrastructure revolving loan program.
Sec. 9. Extension of Medicare incentive payment program for physician scarcity areas.
Sec. 10. Extension of floor on Medicare work geographic adjustment.
Sec. 11. Improving care planning for Medicare home health services.
Sec. 12. Rural health clinic improvements.
Sec. 13. Community health center collaborative access expansion.
Sec. 14. Application of the temporary Medicare payment increase for home health services furnished in a rural area to 2008.
Sec. 15. Extension of increased Medicare payments for rural ground ambulance services.
Sec. 16. Coverage of marriage and family therapist services and mental health counselor services under part
B of the Medicare program.Sec. 17. Extension of treatment of certain physician pathology services under Medicare.
Sec. 18. Medicare remote monitoring pilot projects.
Sec. 19. Facilitating the provision of telehealth services across State lines.
Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals
Section 1886(d)(5)(F)(xiv)(II) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended—
by striking
or, in the case
and all that follows through subparagraph
(G)(iv)
; and
by inserting at the end the following new
sentence: The preceding sentence shall not apply to any hospital with
respect to discharges occurring on or after October 1, 2008.
.
Revision of the Medicare hold harmless provision under the prospective payment system for hospital outpatient department (HOPD) services
Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)) is amended—
in subclause (II), by striking 85
percent
and inserting 100 percent
; and
by adding at the end the following new subclause:
In the case of a sole community hospital (as defined in section 1886(d)(5)(D)(iii)), for covered OPD services furnished during 2008, for which the PPS amount is less than the pre-BBA amount, the amount of payment under this subsection shall be increased by the amount of such difference.
.
Improvement of definition of low-volume hospital for purposes of the Medicare inpatient hospital payment adjustment
Section 1886(d)(12)(C)(i) of the
Social Security Act (42 U.S.C.
1395ww(d)(12)(C)(i)) is amended by inserting (or, beginning with fiscal
year 2008, 2,000 discharges)
after 800
discharges
.
Extension of Medicare wage index reclassifications for certain hospitals
Extension of correction of mid-year reclassification expiration for certain hospitals
In general
In the case of a hospital described in paragraph (2),
effective September 30, 2007, the Secretary of Health and Human Services shall
apply subsection (a) of section 106 of division B of the Tax Relief and Health
Care Act of 2006 (42 U.S.C. 1395ww note) by substituting September 30,
2008
for September 30, 2007
.
Hospital described
A hospital described in this paragraph is a hospital—
that is described in subsection (a) of such section 106; and
that is located in a State with less than 10 people per square mile; or
that is located in a rural area; and
for which the Secretary of Health and Human Services has determined the extension under this subsection to be appropriate.
Additional Extension
The Secretary of Health and Human Services shall extend the special exception reclassification of a sole community hospital located in a State with less than 10 people per square mile (made under the authority of section 1886(d)(5)(I)(i) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(I)(i)) and contained in the final rule promulgated by the Secretary in the Federal Register on August 11, 2004 (69 Fed. Reg. 49107)) for 1 year through September 30, 2008.
Not budget neutral
The provisions of this section shall not be effected in a budget-neutral manner.
Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas
Section 416(b) of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395l–4(b)), as
amended by section 105 of division B of the Tax Relief and Health Care Act of
2006 (42 U.S.C. 1395l note), is amended by striking 3-year
and
inserting 5-year
.
Critical access hospital improvements
Clarification of payment for clinical laboratory tests furnished by critical access hospitals
In general
Section 1834(g)(4) of the Social Security Act (42 U.S.C. 1395m(g)(4)) is amended—
in the heading,
by striking no beneficiary
cost-sharing for
and inserting treatment of
; and
by adding at the end the following new sentence: “For purposes of the preceding sentence and section 1861(mm)(3), clinical diagnostic laboratory services furnished by a critical access hospital shall be treated as being furnished as part of outpatient critical access services without regard to whether—
the individual with respect to whom such services are furnished is physically present in the critical access hospital at the time the specimen is collected;
such individual is registered as an outpatient on the records of, and receives such services directly from, the critical access hospital; or
payment is (or, but for this subsection, would be) available for such services under the fee schedule established under section 1833(h).
.
Effective date
The amendments made by paragraph (1) shall apply to cost reporting periods beginning on or after the date of enactment of this Act.
Elimination of Isolation Test for cost-based ambulance reimbursement
In general
Section 1834(l)(8) of the Social Security Act (42 U.S.C. 1395m(l)(8)) is amended—
in subparagraph (B)—
by
striking owned and
; and
by
inserting (including when such services are provided by the entity under
an arrangement with the hospital)
after hospital
;
and
by striking the comma at the end of subparagraph (B) and all that follows and inserting a period.
Effective date
The amendments made by this subsection shall apply to services furnished on or after January 1, 2008.
Capital infrastructure revolving loan program
In General
Part A of title XVI of the Public Health Service Act (42 U.S.C. 300q et seq.) is amended by adding at the end the following new section:
Capital infrastructure revolving loan program
Authority To Make and Guarantee Loans
Authority to make loans
The Secretary may make loans from the fund established under section 1602(d) to any rural entity for projects for capital improvements, including—
the acquisition of land necessary for the capital improvements;
the renovation or modernization of any building;
the acquisition or repair of fixed or major movable equipment; and
such other project expenses as the Secretary determines appropriate.
Authority to guarantee loans
In general
The Secretary may guarantee the payment of principal and interest for loans made to rural entities for projects for any capital improvement described in paragraph (1) to any non-Federal lender.
Interest subsidies
In the case of a guarantee of any loan made to a rural entity under subparagraph (A), the Secretary may pay to the holder of such loan, for and on behalf of the project for which the loan was made, amounts sufficient to reduce (by not more than 3 percent) the net effective interest rate otherwise payable on such loan.
Amount of Loan
The principal amount of a loan directly made or guaranteed under subsection (a) for a project for capital improvement may not exceed $5,000,000.
Funding Limitations
Government credit subsidy exposure
The total of the Government credit subsidy exposure under the Credit Reform Act of 1990 scoring protocol with respect to the loans outstanding at any time with respect to which guarantees have been issued, or which have been directly made, under subsection (a) may not exceed $50,000,000 per year.
Total amounts
Subject to paragraph (1), the total of the principal amount of all loans directly made or guaranteed under subsection (a) may not exceed $250,000,000 per year.
Capital Assessment and Planning Grants
Nonrepayable grants
Subject to paragraph (2), the Secretary may make a grant to a rural entity, in an amount not to exceed $50,000, for purposes of capital assessment and business planning.
Limitation
The cumulative total of grants awarded under this subsection may not exceed $2,500,000 per year.
Termination of Authority
The Secretary may not directly make or guarantee any loan under subsection (a) or make a grant under subsection (d) after September 30, 2011.
.
Rural Entity Defined
Section 1624 of the Public Health Service Act (42 U.S.C. 300s–3) is amended by adding at the end the following new paragraph:
The term rural entity includes—
a rural health clinic, as defined in section 1861(aa)(2) of the Social Security Act;
any medical facility with at least 1 bed, but with less than 50 beds, that is located in—
a county that is not part of a metropolitan statistical area; or
a rural census tract of a metropolitan statistical area (as determined under the most recent modification of the Goldsmith Modification, originally published in the Federal Register on February 27, 1992 (57 Fed. Reg. 6725));
a hospital that is classified as a rural, regional, or national referral center under section 1886(d)(5)(C) of the Social Security Act; and
a hospital that is a sole community hospital (as defined in section 1886(d)(5)(D)(iii) of the Social Security Act).
For purposes of subparagraph (A), the fact that a clinic, facility, or hospital has been geographically reclassified under the Medicare program under title XVIII of the Social Security Act shall not preclude a hospital from being considered a rural entity under clause (i) or (ii) of subparagraph (A).
.
Conforming Amendments
Section 1602 of the Public Health Service Act (42 U.S.C. 300q–2) is amended—
in subsection
(b)(2)(D), by inserting or 1603(a)(2)(B)
after
1601(a)(2)(B)
; and
in subsection (d)—
in paragraph
(1)(C), by striking section 1601(a)(2)(B)
and inserting
sections 1601(a)(2)(B) and 1603(a)(2)(B)
; and
in paragraph
(2)(A), by inserting or 1603(a)(2)(B)
after
1601(a)(2)(B)
.
Extension of Medicare incentive payment program for physician scarcity areas
Section 1833(u)(1) of the Social Security
Act (42 U.S.C. 1395l(u)(1)) is amended by striking before January 1,
2008
and inserting before January 1, 2010
.
Extension of floor on Medicare work geographic adjustment
Section 1848(e)(1)(E) of the Social Security
Act (42 U.S.C. 1395w–4(e)(1)(E)), as amended by section 102 of division B of
the Tax Relief and Health Care Act of 2006, is amended by striking
before January 1, 2008
and inserting before January 1,
2010
.
Improving care planning for Medicare home health services
In general
Section 1814(a)(2) of the Social Security Act (42 U.S.C. 1395f(a)(2)), in the matter preceding subparagraph (A), is amended—
by inserting
(as those terms are defined in section 1861(aa)(5))
after
clinical nurse specialist
; and
by inserting
, or in the case of services described in subparagraph (C), a physician,
or a nurse practitioner or clinical nurse specialist who is working in
collaboration with a physician in accordance with State law, or a certified
nurse-midwife (as defined in section 1861(gg)) as authorized by State law, or a
physician assistant (as defined in section 1861(aa)(5)) under the supervision
of a physician
after collaboration with a
physician
.
Conforming amendments
Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) is amended—
in paragraph (2)(C), by inserting
, a nurse practitioner, a clinical nurse specialist, a certified
nurse-midwife, or a physician assistant (as the case may be)
after
physician
each place it appears;
in the second sentence, by striking
or clinical nurse specialist
and inserting clinical nurse
specialist, certified nurse-midwife, or physician assistant
;
in the third sentence—
by striking physician
certification
and inserting certification
;
by inserting (or on January
1, 2008, in the case of regulations to implement the amendments made by section
2 of the Home Health Care Planning
Improvement Act of 2007)
after 1981
;
and
by striking a physician
who
and inserting a physician, nurse practitioner, clinical
nurse specialist, certified nurse-midwife, or physician assistant who
;
and
in the fourth sentence, by inserting
, nurse practitioner, clinical nurse specialist, certified
nurse-midwife, or physician assistant
after
physician
.
Section 1835(a) of the Social Security Act (42 U.S.C. 1395n(a)) is amended—
in paragraph (2)—
in the matter preceding
subparagraph (A), by inserting or, in the case of services described in
subparagraph (A), a physician, or a nurse practitioner or clinical nurse
specialist (as those terms are defined in 1861(aa)(5)) who is working in
collaboration with a physician in accordance with State law, or a certified
nurse-midwife (as defined in section 1861(gg)) as authorized by State law, or a
physician assistant (as defined in section 1861(aa)(5)) under the supervision
of a physician
after a physician
; and
in each of clauses (ii) and (iii)
of subparagraph (A) by inserting , a nurse practitioner, a clinical
nurse specialist, a certified nurse-midwife, or a physician assistant (as the
case may be)
after physician
;
in the third sentence, by inserting
, nurse practitioner, clinical nurse specialist, certified
nurse-midwife, or physician assistant (as the case may be)
after
physician;
in the fourth sentence—
by striking physician
certification
and inserting certification
;
by inserting (or on January
1, 2008, in the case of regulations to implement the amendments made by section
2 of the Home Health Care Planning
Improvement Act of 2007)
after 1981
;
and
by striking a physician
who
and inserting a physician, nurse practitioner, clinical
nurse specialist, certified nurse-midwife, or physician assistant who
;
and
in the fifth sentence, by inserting
, nurse practitioner, clinical nurse specialist, certified
nurse-midwife, or physician assistant
after
physician
.
Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—
in subsection (m)—
in the matter preceding paragraph (1)—
by inserting a nurse practitioner
or a clinical nurse specialist (as those terms are defined in subsection
(aa)(5)), a certified nurse-midwife (as defined in section 1861(gg)), or a
physician assistant (as defined in subsection (aa)(5))
after
physician
the first place it appears; and
by inserting a nurse
practitioner, a clinical nurse specialist, a certified nurse-midwife, or a
physician assistant
after physician
the second place it
appears; and
in paragraph (3), by inserting
a nurse practitioner, a clinical nurse specialist, a certified
nurse-midwife, or a physician assistant
after physician
;
and
in subsection (o)(2)—
by inserting , nurse
practitioners or clinical nurse specialists (as those terms are defined in
subsection (aa)(5)), certified nurse-midwives (as defined in section 1861(gg)),
or physician assistants (as defined in subsection (aa)(5))
after
physicians
; and
by inserting , nurse
practitioner, clinical nurse specialist, certified nurse-midwife, physician
assistant,
after physician
.
Section 1895 of the Social Security Act (42 U.S.C. 1395fff) is amended—
in subsection (c)(1), by inserting
, the nurse practitioner or clinical nurse specialist (as those terms
are defined in section 1861(aa)(5)), the certified nurse-midwife (as defined in
section 1861(gg)), or the physician assistant (as defined in section
1861(aa)(5)),
after physician
; and
in subsection (e)—
in paragraph (1)(A), by inserting
, a nurse practitioner or clinical nurse specialist (as those terms are
defined in section 1861(aa)(5)), a certified nurse-midwife (as defined in
section 1861(gg)), or a physician assistant (as defined in section
1861(aa)(5))
after physician
; and
in paragraph (2)—
in the heading, by striking
Physician
certification
and inserting Rule of construction regarding requirement for
certification
; and
by striking
physician
.
Effective Date
The amendments made by this section shall apply to items and services furnished on or after January 1, 2008.
Rural health clinic improvements
Section 1833(f) of the Social Security Act (42 U.S.C. 1395l(f)) is amended—
in paragraph (1),
by striking , and
at the end and inserting a semicolon;
in paragraph (2)—
by inserting
(before 2008)
after in a subsequent year
;
and
by striking the period at the end and inserting a semicolon; and
by adding at the end the following new paragraphs:
in 2008, at $92 per visit; and
in a subsequent year, at the limit established under this subsection for the previous year increased by the percentage increase in the MEI (as so defined) applicable to primary care services (as so defined) furnished as of the first day of that year.
.
Community health center collaborative access expansion
Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended by adding at the end the following:
Miscellaneous Provisions
Rule of construction with respect to rural health clinics
In general
Nothing in this section shall be construed to prevent a community health center from contracting with a federally certified rural health clinic (as defined by section 1861(aa)(2) of the Social Security Act) for the delivery of primary health care services that are available at the rural health clinic to individuals who would otherwise be eligible for free or reduced cost care if that individual were able to obtain that care at the community health center. Such services may be limited in scope to those primary health care services available in that rural health clinic.
Assurances
In order for a rural health clinic to receive funds under this section through a contract with a community health center under paragraph (1), such rural health clinic shall establish policies to ensure—
nondiscrimination based upon the ability of a patient to pay; and
the establishment of a sliding fee scale for low-income patients.
.
Application of the temporary Medicare payment increase for home health services furnished in a rural area to 2008
Section 421 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395fff note), as amended by section 5201(b) of the Deficit Reduction Act of 2005 (42 U.S.C. 1395fff note), is amended—
in the section heading, by striking
One-year
and inserting
Temporary
; and
in subsection (a), by inserting and
episodes and visits ending on or after January 1, 2008, and before January 1,
2009,
after January 1, 2007,
.
Extension of increased Medicare payments for rural ground ambulance services
Section 1834(l)(13) of the Social Security Act (42 U.S.C. 1395m(l)(13)) is amended—
in subparagraph
(A), in the heading, by striking In general
and inserting
For the second half of
2004 and for 2005 and 2006
;
by redesignating subparagraph (B) as subparagraph (C);
by inserting the following after subparagraph (A):
For 2008 and 2009 for rural areas
After computing the rates with respect to ground ambulance services under the other applicable provisions of this subsection, in the case of such services furnished on or after January 1, 2008, and before January 1, 2010, for which the transportation originates in a rural area described in paragraph (9) or in a rural census tract described in such paragraph, the fee schedule established under this section shall provide that the rate for the service otherwise established, after application of any increase under paragraphs (11) and (12), shall be increased by 5 percent.
; and
in subparagraph (C), as redesignated by paragraph (2)—
in the heading,
by striking Application
of increased payments after 2006
and inserting
No effect on subsequent
periods
; and
by adding at the
end the following new sentence: The increased payments under
subparagraph (B) shall not be taken into account in calculating payments for
services furnished after the period specified in such
subparagraph.
.
Coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program
Coverage of Services
In general
Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended—
in subparagraph
(Z), by striking and
after the semicolon at the end;
in subparagraph
(AA), by inserting and
after the semicolon at the end;
and
by adding at the end the following new subparagraph:
marriage and family therapist services (as defined in subsection (ccc)(1)) and mental health counselor services (as defined in subsection (ccc)(3));
.
Definitions
Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the end the following new subsection:
Marriage and Family Therapist Services; Marriage and Family Therapist; Mental Health Counselor Services; Mental Health Counselor
The term marriage and family therapist services means services performed by a marriage and family therapist (as defined in paragraph (2)) for the diagnosis and treatment of mental illnesses, which the marriage and family therapist is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as an incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.
The term marriage and family therapist means an individual who—
possesses a master’s or doctoral degree which qualifies for licensure or certification as a marriage and family therapist pursuant to State law;
after obtaining such degree has performed at least 2 years of clinical supervised experience in marriage and family therapy; and
in the case of an individual performing services in a State that provides for licensure or certification of marriage and family therapists, is licensed or certified as a marriage and family therapist in such State.
The term mental health counselor services means services performed by a mental health counselor (as defined in paragraph (4)) for the diagnosis and treatment of mental illnesses which the mental health counselor is legally authorized to perform under State law (or the State regulatory mechanism provided by the State law) of the State in which such services are performed, as would otherwise be covered if furnished by a physician or as incident to a physician’s professional service, but only if no facility or other provider charges or is paid any amounts with respect to the furnishing of such services.
The term mental health counselor means an individual who—
possesses a master’s or doctor’s degree in mental health counseling or a related field;
after obtaining such a degree has performed at least 2 years of supervised mental health counselor practice; and
in the case of an individual performing services in a State that provides for licensure or certification of mental health counselors or professional counselors, is licensed or certified as a mental health counselor or professional counselor in such State.
.
Provision for payment under part B
Section 1832(a)(2)(B) of the Social Security Act (42 U.S.C. 1395k(a)(2)(B)) is amended by adding at the end the following new clause:
marriage and family therapist services (as defined in section 1861(ccc)(1)) and mental health counselor services (as defined in section 1861(ccc)(3));
.
Amount of payment
Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended—
by striking
and (V)
and inserting (V)
; and
by inserting
before the semicolon at the end the following: , and (W) with respect to
marriage and family therapist services and mental health counselor services
under section 1861(s)(2)(BB), the amounts paid shall be 80 percent of the
lesser of the actual charge for the services or 75 percent of the amount
determined for payment of a psychologist under subparagraph (L)
.
Exclusion of marriage and family therapist services and mental health counselor services from skilled nursing facility prospective payment system
Section
1888(e)(2)(A)(ii) of the Social Security
Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting
marriage and family therapist services (as defined in section
1861(ccc)(1)), mental health counselor services (as defined in section
1861(ccc)(3)),
after qualified psychologist
services,
.
Inclusion of marriage and family therapists and mental health counselors as practitioners for assignment of claims
Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C. 1395u(b)(18)(C)) is amended by adding at the end the following new clauses:
A marriage and family therapist (as defined in section 1861(ccc)(2)).
A mental health counselor (as defined in section 1861(ccc)(4)).
.
Coverage of Certain Mental Health Services Provided in Certain Settings
Rural health clinics and federally qualified health centers
Section
1861(aa)(1)(B) of the Social Security
Act (42 U.S.C. 1395x(aa)(1)(B)) is amended by striking or by
a clinical social worker (as defined in subsection (hh)(1))
and
inserting , by a clinical social worker (as defined in subsection
(hh)(1)), by a marriage and family therapist (as defined in subsection
(ccc)(2)), or by a mental health counselor (as defined in subsection
(ccc)(4))
.
Hospice programs
Section 1861(dd)(2)(B)(i)(III) of the
Social Security Act (42 U.S.C.
1395x(dd)(2)(B)(i)(III)) is amended by inserting or one marriage and
family therapist (as defined in subsection (ccc)(2))
after
social worker
.
Authorization of Marriage and Family Therapists To Develop Discharge Plans for Post-Hospital Services
Section 1861(ee)(2)(G) of the
Social Security Act (42 U.S.C.
1395x(ee)(2)(G)) is amended by inserting marriage and family therapist
(as defined in subsection (ccc)(2)),
after social
worker,
.
Effective Date
The amendments made by this section shall apply with respect to services furnished on or after January 1, 2008.
Extension of treatment of certain physician pathology services under Medicare
Section 542(c) of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000 (as enacted into law
by section 1(a)(6) of Public Law 106–554), as amended by section 732 of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42
U.S.C. 1395w–4 note) and section 104 of division B of the Tax Relief and Health
Care Act of 2006 (42 U.S.C. 1395w–4 note), is amended by striking and
2007
and inserting 2007, 2008, and 2009
.
Medicare remote monitoring pilot projects
Pilot projects
In general
Not later than 9
months after the date of enactment of this Act, the Secretary of Health and
Human Services (in this section referred to as the Secretary
)
shall conduct pilot projects under title XVIII of the Social Security Act for
the purpose of providing incentives to home health agencies to utilize home
monitoring and communications technologies that—
enhance health outcomes for Medicare beneficiaries; and
reduce expenditures under such title.
Site requirements
Urban and Rural
The Secretary shall conduct the pilot projects under this section in both urban and rural areas.
Site in a small state
The Secretary shall conduct at least 3 of the pilot projects in a State with a population of less than 1,000,000.
Definition of home health agency
In this section, the term home health
agency
has the meaning given that term in section 1861(o) of the Social
Security Act (42 U.S.C. 1395x(o)).
Medicare beneficiaries within the scope of projects
The Secretary shall specify the criteria for identifying those Medicare beneficiaries who shall be considered within the scope of the pilot projects under this section for purposes of the application of subsection (c) and for the assessment of the effectiveness of the home health agency in achieving the objectives of this section. Such criteria may provide for the inclusion in the projects of Medicare beneficiaries who begin receiving home health services under title XVIII of the Social Security Act after the date of the implementation of the projects.
Incentives
Performance targets
The Secretary shall establish for each home health agency participating in a pilot project under this section a performance target using one of the following methodologies, as determined appropriate by the Secretary:
Adjusted historical performance target
The Secretary shall establish for the agency—
a base expenditure amount equal to the average total payments made to the agency under parts A and B of title XVIII of the Social Security Act for Medicare beneficiaries determined to be within the scope of the pilot project in a base period determined by the Secretary; and
an annual per capita expenditure target for such beneficiaries, reflecting the base expenditure amount adjusted for risk and adjusted growth rates.
Comparative performance target
The Secretary shall establish for the agency a comparative performance target equal to the average total payments under such parts A and B during the pilot project for comparable individuals in the same geographic area that are not determined to be within the scope of the pilot project.
Incentive
Subject to paragraph (3), the Secretary shall pay to each participating home care agency an incentive payment for each year under the pilot project equal to a portion of the Medicare savings realized for such year relative to the performance target under paragraph (1).
Limitation on expenditures
The Secretary shall limit incentive payments under this section in order to ensure that the aggregate expenditures under title XVIII of the Social Security Act (including incentive payments under this subsection) do not exceed the amount that the Secretary estimates would have been expended if the pilot projects under this section had not been implemented.
Waiver authority
The Secretary may waive such provisions of titles XI and XVIII of the Social Security Act as the Secretary determines to be appropriate for the conduct of the pilot projects under this section.
Report to Congress
Not later than 5 years after the date that the first pilot project under this section is implemented, the Secretary shall submit to Congress a report on the pilot projects. Such report shall contain a detailed description of issues related to the expansion of the projects under subsection (f) and recommendations for such legislation and administrative actions as the Secretary considers appropriate.
Expansion
If the Secretary determines that any of the pilot projects under this section enhance health outcomes for Medicare beneficiaries and reduce expenditures under title XVIII of the Social Security Act, the Secretary may initiate comparable projects in additional areas.
Incentive payments have no effect on other Medicare payments to agencies
An incentive payment under this section—
shall be in addition to the payments that a home health agency would otherwise receive under title XVIII of the Social Security Act for the provision of home health services; and
shall have no effect on the amount of such payments.
Facilitating the provision of telehealth services across State lines
In general
For purposes of expediting the provision of telehealth services, for which payment is made under the Medicare program, across State lines, the Secretary of Health and Human Services shall, in consultation with representatives of States, physicians, health care practitioners, and patient advocates, encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across State lines.
Definitions
In subsection (a):
Telehealth service
The term telehealth service has the meaning given that term in subparagraph (F) of section 1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
Physician, practitioner
The terms physician and practitioner have the meaning given those terms in subparagraphs (D) and (E), respectively, of such section.
Medicare program
The term Medicare program
means the
program of health insurance administered by the Secretary of Health and Human
Services under title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.).