text: SECTION 1. SHORT TITLE; PURPOSE.
  
      (a) Short Title.--This Act may be cited as the ``Preserving 
  Equitable Access to Community-based Home Health (PEACH) Act of 2009''.
      (b) Purpose.--It is the purpose of this Act to preserve access to 
  home health services for all Americans, regardless of their ability to 
  pay or their severity of illness.
  
  SEC. 2. FINDINGS.
  
      The Congress finds the following:
              (1) The Medicare home health benefit is vulnerable to 
          agency selection of the most profitable beneficiaries and 
          avoidance of the most complex and costly beneficiaries.
              (2) Such ``cherry picking'' by some home health agencies 
          compromises access to care for the most complex, highest risk 
          beneficiaries.
              (3) The Government Accountability Office has reported that 
          hospital discharge planners have difficulty placing more than 
          10 percent of eligible patients in home health due to their 
          extensive care needs.
              (4) Proposals to reduce Medicare payments to home health 
          agencies (in response to large aggregate margins across all 
          home health agencies) may undermine the financial viability of 
          mission-driven and non-profit home health agencies, which often 
          have low to negative margins, while allowing high-margin 
          agencies to remain in operation.
  
  SEC. 3. SUPPLEMENTAL PAYMENTS FOR PEACH AGENCIES.
  
      (a) In General.--There shall be established a fund (to be known as 
  the ``PEACH fund'') from which home health agencies meeting specified 
  criteria shall be paid supplemental amounts in addition to their 
  statutory payment amounts under title XVIII of the Social Security Act. 
  Is this to be a trust fund? Where is this fund to be established? Who 
  adminsters it? What are the sources of funding that goes into the fund? 
  What are the allowed uses of such funding?
      (b) Peach Program.--Title XVIII of the Social Security Act is 
  amended by inserting after section 1895 the following new section:
  
                 ``supplemental payments for peach agencies
  
      ``Sec. 1895A.  (a) Designation.--
              ``(1) In general.--The Secretary shall designate as a 
          `PEACH agency' any home health agency that meets the criteria 
          under paragraph (2).
              ``(2) Criteria.--The Secretary may not designate a home 
          health agency as a PEACH agency unless the home health agency 
          meets the following criteria:
                      ``(A) The home health agency is certified for 
                  participation under this title.
                      ``(B) The home health agency offers--
                              ``(i) the complete range of home health 
                          services as defined under section 1861(m) of 
                          this title;
                              ``(ii) the complete range of home health 
                          services on a 24 hours per day, 7 days per week 
                          on-call basis; and
                              ``(iii) its services to all eligible 
                          beneficiaries or enrollees under this title 
                          and/or title XIX, and uninsured individuals up 
                          to its service capacity, regardless of their 
                          ability to pay or the complexity or intensity 
                          of care they require.
                      ``(C) The home health agency provides charity care 
                  in an amount greater than or equal to 1 percent of its 
                  total revenue.
                      ``(D) The home health agency agrees that the 
                  Secretary may, by statistical or other means, verify on 
                  an annual basis that the agency meets the criteria 
                  defined in this paragraph, and that the agency will be 
                  subject to disqualification from the PEACH program if 
                  such criteria are not met.
      ``(b) Supplemental Payments.--
              ``(1) In general.--Subject to the availability of funds 
          under subsection (c), the Secretary shall make supplemental 
          payments to PEACH agencies based on information submitted by 
          the agency on an additional schedule in the Medicare cost 
          report.
              ``(2) Cost reporting.--The Secretary shall implement an 
          additional schedule, as a component of the cost reporting 
          process, on which home health agencies may report information 
          the Secretary deems necessary for designation and payment as a 
          PEACH agency.
              ``(3) Amount and timing for first year as peach agency.--
                      ``(A) The supplemental payment made to a home 
                  health agency for the first year in which such agency 
                  is designated a PEACH agency under this section shall 
                  be equal to its shortfall in that year, defined as the 
                  sum of--
                              ``(i) the aggregate reasonable cost of home 
                          health services delivered under parts A and B 
                          of this title by the PEACH agency for such 
                          year, less the aggregate payments received by 
                          the PEACH agency pursuant to section 1895;
                              ``(ii) the aggregate actual costs of home 
                          health and home and community based services 
                          delivered by the agency under sections 
                          1905(a)(7), 1905(a)(22), and 1915(c) through 
                          (e) of title XIX for such year, less the 
                          aggregate payments received by the PEACH agency 
                          for such services under that title; and
                              ``(iii) the aggregate cost of uncompensated 
                          home health services delivered by the PEACH 
                          agency for such year.
                      ``(B) The supplemental payment under subparagraph 
                  (A) shall be paid within 90 days of receipt of the 
                  annual cost report by the Secretary.
              ``(4) Amount and timing for subsequent years.--For each 
          year after the first year in which a home health agency is 
          designated a PEACH agency, a PEACH agency shall receive interim 
          supplemental payments based on--
                      ``(A) the intervals at which the agency submits 
                  cost reports; and
                      ``(B) the estimated shortfall, as defined in 
                  subparagraph (3)(A), for the year or interval in 
                  question.
      ``(c) Funding.--Supplemental payments under this section shall be--
              ``(1) paid from the PEACH fund, which shall be capped at 
          $500,000,000 annually and shall be administered by the 
          Secretary; and
              ``(2) paid to PEACH agencies--
                      ``(A) pursuant to subsection (b); or
                      ``(B) if the PEACH fund is insufficient to cover 
                  all the supplemental payments that should be paid under 
                  subsection (b), in proportion to each agency's 
                  shortfall relative to the aggregate shortfall of all 
                  PEACH agencies for the year in question.
          In any year in which the Secretary determines that the PEACH 
          fund will not cover the aggregate estimated shortfall of all 
          PEACH agencies, the Secretary shall make a preliminary 
          supplemental payment to each PEACH agency within 90 days of 
          receipt of its annual cost report and, if funds remain, an 
          additional supplemental payment after all PEACH agency cost 
          reports have been received.
      ``(d) Definitions.--For purposes of this section--
              ``(1) the term `charity care' means home health services 
          that are provided to an individual who is--
                      ``(A) not eligible for payment under this title, 
                  under title XIX, or by any other third-party payer; and
                      ``(B) unable to pay any portion of the full cost of 
                  care, including any amount subsidized or otherwise 
                  discounted due to an individual's inability to pay; and
              ``(2) the term `uncompensated care' means home health 
          services provided to an individual by a home health agency with 
          the knowledge that the individual will be financially unable to 
          pay for the services.''.
      (c) Conforming Amendment.--Section 1895(a) of the Social Security 
  Act is amended by inserting before the period at the end the following: 
  ``and the provisions of section 1895A''.
  
  SEC. 4. REGULATIONS.
  
      The Secretary shall issue such regulations as are necessary and 
  appropriate for the implementation of the provisions of this Act.
  
  SEC. 5. AUTHORIZATION OF APPROPRIATIONS.
  
      There is authorized for appropriation $500,000,000 for each fiscal 
  year beginning with fiscal year 2010 for purposes of carrying out the 
  purposes of this Act. Is there anything this funds other than the PEACH 
  fund? Should this go into the provision creating that fund?
target: Preserving Equitable Access to Community-based Home Health (PEACH) Act of 2009 - Establishes the PEACH fund from which home health agencies meeting specified criteria shall be paid supplemental amounts in addition to their statutory payment amounts under title XVIII (Medicare) of the Social Security Act (SSA).
  
  Amends SSA title XVIII to direct the Secretary of Health and Human Services (HHS) to make supplemental payments to certain community-based home health agencies that the Secretary has designated as PEACH agencies for estimated shortfalls due to providing uncompensated care.
feat_title: To amend title XVIII of the Social Security Act to ensure access to quality home health services for all Americans, and for other purposes.