Medicare Home Health Fraud Reduction Act - Amends title XVIII (Medicare) of the Social Security Act to prohibit payments to a skilled home health agency under the prospective payment system for any episode of care to the extent that it exceeds the applicable episode utilization limit established by the Secretary of Health and Human Services (HHS).
Specifies the formula for establishing an episode utilization limit for a skilled home health agency.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3245 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 3245
To amend title XVIII of the Social Security Act to establish a maximum
threshold for episode reimbursement to skilled home health agencies
under Medicare.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 4, 2013
Mr. Matheson (for himself and Mr. Guthrie) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on Energy and Commerce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish a maximum
threshold for episode reimbursement to skilled home health agencies
under Medicare.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Home Health Fraud Reduction
Act''.
SEC. 2. ESTABLISHMENT OF MAXIMUM THRESHOLD FOR EPISODE REIMBURSEMENT TO
SKILLED HOME HEALTH AGENCIES UNDER MEDICARE.
Section 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b))
is amended by adding at the end the following new paragraph:
``(7) Episode utilization rate.--
``(A) Payment limitation.--For 2014 and each
subsequent year, payment may not be made to a skilled
home health agency under this section for an episode of
care to the extent that such episode exceeds the
applicable episode utilization limit established under
subparagraph (B) for the agency for the year.
``(B) Applicable episode utilization limit.--
``(i) In general.--For 2014 and each
subsequent year, the Secretary shall establish
an episode utilization limit for a skilled home
health agency that is equal to the product of--
``(I) in the case of a skilled home
health agency located in--
``(aa) a rural area, 3.3
episodes; and
``(bb) in an area not
described in item (aa), 2.7
episodes; and
``(II) the total number of Medicare
beneficiaries for the skilled home
health agency (as defined in clause
(iii)).
``(ii) Episode defined.--For purposes of
this paragraph, the term `episode' has the
meaning given such term for purposes of section
484.205 of title 42, Code of Federal
Regulations (as in effect on October 1, 2011)
and includes partial episodes for which a
partial episode payment is made pursuant to
such section to the extent such partial episode
is a percentage of a full episode.
``(iii) Total number of medicare
beneficiaries defined.--
``(I) In general.--For purposes of
clause (i)(II), the term `total number
of Medicare beneficiaries' means, with
respect to a skilled home health agency
and year, the total number of
unduplicated individuals who were
furnished home health services under
this title in the year by the agency.
``(II) Special rule.--In
calculating the total number of
Medicare beneficiaries under subclause
(I), in any case where an individual is
furnished skilled home health care
services from more than one agency, the
number of such individuals being
counted toward the applicable episode
utilization limit for each such agency
shall be proportionally credited in an
amount equal to the percentage of the
total number of episodes provided by
the agency.''.
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Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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