Home Health Documentation and Program Improvement Act of 2017
This bill requires the Centers for Medicare & Medicaid Services (CMS) to use an individual's medical record from a home-health agency, as appropriate, to support certification of such individual's Medicare eligibility for home-health services.
The bill requires the CMS to establish a process for home-health agencies that are entitled to an administrative appeal after being denied eligibility for Medicare reimbursement to, instead, enter into a settlement with the CMS.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2663 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 2663
To amend title XVIII of the Social Security Act to make changes to
documentation of eligibility for Medicare home health services, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 25, 2017
Mr. Marchant (for himself and Mr. Blumenauer) 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 make changes to
documentation of eligibility for Medicare home health services, and for
other purposes.
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 ``Home Health Documentation and
Program Improvement Act of 2017''.
SEC. 2. INFORMATION TO SATISFY DOCUMENTATION OF MEDICARE ELIGIBILITY
FOR HOME HEALTH SERVICES.
(a) Part A.--Section 1814(a) of the Social Security Act (42 U.S.C.
1395f(a)) is amended by inserting before ``For purposes of paragraph
(2)(C),'' the following new sentence: ``For purposes of documentation
for physician certification and recertification made under paragraph
(2) on or after January 1, 2018, and made with respect to home health
services furnished by a home health agency, in addition to using
documentation in the medical record of the physician who so certifies
or the medical record of the acute or post-acute care facility (in the
case that home health services were furnished to an individual who was
directly admitted to the home health agency from such a facility), the
Secretary shall use documentation in the medical record of the home
health agency as supporting material, as appropriate to the case
involved.''.
(b) Part B.--Section 1835(a) of the Social Security Act (42 U.S.C.
1395n(a)) is amended by inserting before ``For purposes of paragraph
(2)(A),'' the following new sentence: ``For purposes of documentation
for physician certification and recertification made under paragraph
(2) on or after January 1, 2018, and made with respect to home health
services furnished by a home health agency, in addition to using
documentation in the medical record of the physician who so certifies
or the medical record of the acute or post-acute care facility (in the
case that home health services were furnished to an individual who was
directly admitted to the home health agency from such a facility), the
Secretary shall use documentation in the medical record of the home
health agency as supporting material, as appropriate to the case
involved.''.
SEC. 3. VOLUNTARY SETTLEMENT OF HOME HEALTH CLAIMS.
(a) Settlement Process for Home Health Claims.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall establish a settlement process under which a
home health agency entitled to an eligible administrative
appeal has the option to enter into a settlement with the
Secretary that is reached in a manner consistent with the
succeeding paragraphs of this subsection.
(2) Process and consideration of home health claims.--A
settlement under paragraph (1) with a home health agency that
is with respect to an eligible administrative appeal may only
be reached in accordance with the following process:
(A) A settlement under such paragraph with the home
health agency shall be with respect to all claims by
such agency, subject to paragraph (4), that, as of the
date of such settlement, are under an eligible
administrative appeal.
(B) For the duration of the settlement process with
such agency, an eligible administrative appeal that is
with respect to any such claim by such agency shall be
suspended.
(C) Under the settlement process, the Secretary
shall determine an aggregate amount to be paid to the
home health agency with respect to all claims by such
agency that are under an eligible administrative appeal
in the following manner:
(i) The Secretary shall, for purposes of
applying clause (ii) with respect to all
settlements under paragraph (1), select a
percentage. In selecting such percentage, the
Secretary shall consider the percentage used
under the Centers for Medicare & Medicaid
Services hospital appeals settlement that began
on October 31, 2014.
(ii) The Secretary shall, with respect to
each denied claim for such agency that is under
an eligible administrative appeal, calculate an
amount (referred to in this subparagraph as an
``individual claim amount'') by multiplying the
net payable amount for such claim by the
percentage selected under clause (i).
(iii) Such aggregate amount with respect to
such agency shall be determined by calculating
the total sum of all the individual claim
amounts calculated under clause (ii) with
respect to such agency.
(3) Effect of process.--
(A) Effect of settlement.--
(i) Further appeal.--As part of any
settlement under paragraph (1) between a home
health agency and the Secretary, such home
health agency shall be required to forego the
right to an administrative appeal under section
1869 of the Social Security Act (42 U.S.C.
1395ff) or section 1878 of such Act (42 U.S.C.
1395oo) (including any redetermination,
reconsideration, hearing, or review) with
respect to any claims for home health services
that are subject to the settlement.
(ii) Judicial review.--There shall be no
administrative or judicial review under such
section 1869 or otherwise of a settlement under
paragraph (1) and the claims covered by the
settlement.
(B) Effect of no settlement.--In the event that the
process described in paragraph (2) does not, with
respect to a home health agency, result in a settlement
under paragraph (1) with such agency, any appeal under
such section 1869 that is with respect to a claim by
such agency that was suspended pursuant to paragraph
(2)(B) shall resume under such section.
(4) Coordination with law enforcement.--The Secretary of
Health and Human Services shall establish a process under which
individuals in the Department of Health and Human Services
responsible for executing a settlement under paragraph (1) may,
in order to avoid the inadvertent settlement of cases that
involve fraud or other criminal activity, coordinate with
appropriate law enforcement agencies.
(b) No Entitlement to Settlement Process.--Nothing in this section
shall be construed as creating an entitlement to enter into a
settlement process established pursuant to subsection (a).
(c) Eligible Administrative Appeal Defined.--For purposes of this
section, the term ``eligible administrative appeal'' means an appeal
under section 1869 of the Social Security Act (42 U.S.C. 1395ff)
(including any redetermination, reconsideration, hearing, or review)--
(1) that is with respect to one or more claims that--
(A) are for home health services that--
(i) were furnished on or after January 1,
2011, and before January 1, 2015; and
(ii) were reasonable and necessary under
section 1862(a)(1)(A) of such Act (42 U.S.C.
1395y(a)(1)(A)); and
(B) were timely filed consistent with section
1814(a)(1) of such Act (42 U.S.C. 1395f(a)(1)) or
sections 1835(a)(1) and 1842(b)(3) of such Act (42
U.S.C. 1395n(a)(1), 1395u(b)(3)); and
(2) either--
(A) was timely filed consistent with section 1869
of such Act (42 U.S.C. 1395ff) and is pending; or
(B) for which the applicable time frame to file an
appeal has not expired.
(d) Conforming Amendment.--Section 1869 of the Social Security Act
(42 U.S.C. 1395ff) is amended by adding at the end the following new
subsection:
``(j) Application With Respect to Certain Home Health Claims.--For
the application of the provisions of this section with respect to
certain claims for home health services that were furnished on or after
January 1, 2011, and before January 1, 2015, see section 3 of the Home
Health Documentation and Program Improvement Act of 2017.''.
<all>
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 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.
Referred to the Subcommittee on Health.
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