Page:United States Statutes at Large Volume 102 Part 1.djvu/769

 PUBLIC LAW 100-360—JULY 1, 1988

102 STAT. 731

"Payment for in-home care for chronically dependent individuals shall he paid on the basis of an hour of such care provided. In applying paragraph (2) in the case of an organization receiving payment under clause (A) of paragraph (1) or under a reasonable cost reimbursement contract under section 1876 and providing coverage of in-home care, the Secretary shall provide for an appropriate adjustment in the payment amounts otherwise made to reflect the a ^ r ^ a t e increase in payments that would otherwise be made with respect to enrollees in the organization if payments were made other than under such clause or such a contract if payments were to be made on an individual-by-individual basis.". (d) CERTIFICATION.—Section 1835(a)(2) (42 U.S.C. 1395n(a)(2)), as amended by section 203(d) of this Act, is amended— (1) by striking "and" at the end of subparagraph (F); (2) by striking the period at the end of subparagraph (G) and inserting in lieu thereof "; and"; and (3) by inserting after subparagraph (G) the following new subparagraph: "OH) in the case of in-home care provided to a chronically dependent individual during a 12-month period, the individual was a chronically dependent individual during the 3month period imme(tiately preceding the beginning of the 12-month period.".

Contracts.

(e) STANDARDS FOR UTILIZATION.—

(1) Section 1862(a) (42 U.S.C. 1395y(a)), as amended by section 204(d)(2) of this Act, is amended— (A) in paragraph (1)— (i) by striking "and" at the end of subparagraph (E), (ii) by adding "suid" at the end of subparagraph (F), and (iv) by adding at the end the following new subparagraph: "(G) in the case of in-home care for chronically dependent individuals, which is not reasonable and necessary to assure the health and condition of the individual is maintained in the individual's noninstitutional residence;"; and (B) in paragraph (6), by inserting "and except, in the case of in-home care, as is otherwise permitted under paragraph (IXG)" after "paragraph (I)(C)". (2) The Secretary of Health and Human Services shall take appropriate efforts to assure the quality, and provide for appropriate utilization of, in-home care for chronically dependent individuals under the amendments made by this section. (f) EFFECTIVE DATE.—The amendments made by this section shall apply to items and services furnished on or after January 1, 1990. (g) STUDY OF ALTERNATIVE OUT-OF-HOBIE SERVICES.—The Secretary of Health and Human Services shall study, and report to Congress, not later than 18 months after the date of the enactment of this Act, on the advisability of providing, to chronically dependent individuals eligible for in-home care under the amendments made by this section, out-of-home services (such as adult day care services or nursing facility services) as alternative services to in-home care. SEC. 206. EXTENDING HOME HEALTH SERVICES.

(a) IN GENERAL.—Section 1861(m) (42 U.S.C. 1395x(m)) is amended by adding at the end the following new sentence: "For purposes of paragraphs (1) and (4) and sections 1814(a)(2)(C) and 1835(a)(2)(A),

42 USC 1395k note. 42 USC 1395k note. Reports. 42 USC 1395k note.

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