PUBLIC LAW 105-33 —AUG. 5, 1997 111 STAT. 467
- (I) an agency-specific per beneficiary annual limitation
calculated based 75 percent on 98 percent of the reasonable costs (including nonroutine medical supplies) for the agency's 12-month cost reporting period ending during fiscal year 1994, and based 25 percent on 98 percent of the standardized regional average of such costs for the agency's census division, as applied to such agency, for cost reporting periods ending during fiscal year 1994, such costs updated by the home health market basket index; and "(11) the agency's unduplicated census count of patients (entitled to benefits under this title) for the cost reporting period subject to the limitation. '(vi) For services furnished by home health agencies for cost Applicability reporting periods beginning on or after October 1, 1997, the following rules apply: "(I) For new providers and those providers without a 12- month cost reporting period ending in fiscal year 1994, the {)er beneficiary limitation shall be equal to the median of these imits (or the Secretary's best estimates thereof) applied to other home health agencies as determined by the Secretary. A home health agency that has altered its corporate structure or name shall not be considered a new provider for this purpose. "(II) For beneficiaries who use services furnished by more than one home health agency, the per beneficiary limitations shall be prorated among the agencies. "(vii)(I) Not later than January 1, 1998, the Secretary shall establish per visit limits applicable for fiscal year 1998, and not later than April 1, 1998, the Secretary shall establish per beneficiary limits under clause (v)(I) for fiscal year 1998. "(II) Not later than August 1 of each year (beginning in 1998) the Secretary shall establish the limits applicable under this subparagraph for services furnished during the fiscal year beginning October 1 of the year.". (d) DEVELOPME>rr OF CASE MIX SYSTEM.— The Secretary of Health and Human Services shall expand research on a prospective payment system for home health agencies under the medicare program that ties prospective payments to a unit of service, including an intensive effort to develop a reliable case mix adjuster that explains a significant amount of the variances in costs. (e) SUBMISSION OF DATA FOR CASE MIX SYSTEM.— Effective for cost reporting periods beginning on or after October 1, 1997, the Secretary of Health and Human Services may require all home health agencies to submit additional information that the Secretary considers necessary for the development of a reliable case mix system. SEC. 4603. PROSPECTIVE PAYMENT FOR HOME HEALTH SERVICES. (a) IN GENERAL.— Title XVIII (42 U.S.C. 1395 et seq.) (as amended by section 4801) is amended by adding at the end the following: 42 USC 1395f!r note. Effective date. 42 USC 1395fff note. PROSPECTIVE PAYMENT FOR HOME HEALTH SERVICES 42 USC 1395fff. "SEC. 1895. (a) IN GENERAL. —Notwithstanding section 186l(v), the Secretary shall provide, for cost reporting periods beginning on or after October 1, 1999, for payments for home health services in accordance with a prospective payment system established by the Secretary under this section.
�
