II

107TH CONGRESS

1ST SESSION S. 1169

To streamline the regulatory processes applicable to home health agencies

under the medicare program under title XVIII of the Social Security

Act and the medicaid program under title XIX of such Act, and for

other purposes.

IN THE SENATE OF THE UNITED STATES

JULY 12, 2001

Mr. FEINGOLD (for himself, Mr. MURKOWSKI, Ms. COLLINS, and Mr. KERRY)

introduced the following bill; which was read twice and referred to the

Committee on Finance

A BILL

To streamline the regulatory processes applicable to home

health agencies under the medicare program under title

XVIII of the Social Security Act and the medicaid program under title XIX of such Act, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Home Health Nurse and Patient Act of 2001’’.

6 (b) TABLE OF CONTENTS.—The table of contents of

7 this Act is as follows:
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Sec. 1. Short title; table of contents.

Sec. 2. Findings.

Sec. 3. Definitions.

Sec. 4. OASIS Task Force (OTF).

Sec. 5. Elimination of mandatory requirement to collect Outcomes Assessment

and Information Set (OASIS) data from certain individuals.

Sec. 6. Improving the claims review process for dually-eligible medicare and

medicaid beneficiaries receiving home health services.

Sec. 7. Claims Review and Audit Task Force (CRATF).

Sec. 8. Implementation of Task Force recommendations.

1 SEC. 2. FINDINGS.

2 The Senate makes the following findings:

3 (1) The Outcomes Assessment and Information

4 Set (in this section referred to as ‘‘OASIS’’) includes

5 information regarding the health and functional sta6 tus of patients of home health agencies, the use of

7 health services by such patients, the living conditions

8 of such patients, and the social support provided to

9 such patients, that is necessary to assess the quality

10 of care being provided to medicare and medicaid pa11 tients by home health agencies.

12 (2) According to the Comptroller General of the

13 United States, the average additional time that is

14 necessary for a home health agency to comply with

15 the OASIS requirement for a start-of-care assess16 ment is 61 minutes more than the amount of time

17 to comply with such requirement estimated by the

18 Centers for Medicare & Medicaid Services.

19 (3) Existing Federal regulations and associated

20 paperwork requirements are excessively straining
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1 home health agencies and their clinical staff, and are

2 often reported by nurses to be the primary contribu3 tors to their decreased job satisfaction.

4 (4) Many nurses and home health aides are

5 leaving the home health care profession and patients

6 are staying in the hospital longer than necessary.

7 (5) A 2000 national survey of home health

8 agencies by the Hospital and Healthcare Compensa9 tion Service reported a 21 percent turnover rate for

10 registered nurses, a 24 percent turnover rate for li11 censed practical nurses, and a 28 percent turnover

12 rate for home health aides.

13 (6) In its May 17, 2001 report titled ‘‘Nursing

14 Workforce—Recruitment and Retention of Nurses

15 and Nurse Aides Is a Growing Concern’’, the Gen16 eral Accounting Office reported that the jobs for

17 nurse aides working in home health care are pro18 jected to increase by 58 percent, from 746,000 in

19 1998 to 1,200,000 in 2008.

20 SEC. 3. DEFINITIONS.

21 In this Act:

22 (1) COMPREHENSIVE ASSESSMENT OF PA23 TIENTS.—The term ‘‘comprehensive assessment of

24 patients’’ means the rule published by the Centers

25 for Medicare & Medicaid Services that requires, as
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1 a condition of participation in the medicare pro2 gram, a home health agency to provide a patient3 specific comprehensive assessment that accurately

4 reflects the patient’s current status and that incor5 porates the Outcome and Assessment Information

6 Set (OASIS).

7 (2) CRATF.—The term ‘‘CRATF’’ means the

8 Claims Review and Audit Task Force established

9 under section 7.

10 (3) HOME HEALTH AGENCY.—The term ‘‘home

11 health agency’’ has the meaning given that term

12 under section 1861(o) of the Social Security Act (42

13 U.S.C. 1395x(o)).

14 (4) OUTCOME AND ASSESSMENT INFORMATION

15 SET; OASIS.—The terms ‘‘Outcome and Assessment

16 Information Set’’ and ‘‘OASIS’’ mean the standard

17 provided under the rule relating to data items that

18 must be used in conducting a comprehensive assess19 ment of patients.

20 (5) MEDICAID BENEFICIARY.—The term ‘‘med21 icaid beneficiary’’ means an individual who is eligible

22 for medical assistance under a State plan under the

23 medicaid program under title XIX of the Social Se24 curity Act (42 U.S.C. 1396 et seq.).
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1 (6) MEDICARE BENEFICIARY.—The term

2 ‘‘medicare beneficiary’’ means an individual who is

3 entitled to benefits under part A of title XVIII of

4 the Social Security Act (42 U.S.C. 1395c et seq.) or

5 enrolled under part B of such title (42 U.S.C. 1395j

6 et seq.), including an individual who is enrolled in a

7 Medicare+Choice plan under part C of such title

8 (42 U.S.C. 1395w–21 et seq.).

9 (7) OTF.—The term ‘‘OTF’’ means the OASIS

10 Task Force established under section 4.

11 (8) SECRETARY.—The term ‘‘Secretary’’ means

12 the Secretary of Health and Human Services, acting

13 through the Administrator of the Centers for Medi14 care & Medicaid Services.

15 SEC. 4. OASIS TASK FORCE (OTF).

16 (a) ESTABLISHMENT OF THE OASIS TASK FORCE.—

17 The Secretary shall establish the OASIS Task Force (in

18 this section referred to as the ‘‘OTF’’) in accordance with

19 the provisions of section 1114(f) of the Social Security Act

20 (42 U.S.C. 1314(f)).

21 (b) MEMBERSHIP.—The OTF shall be composed of

22 11 members appointed by the Secretary as follows:

23 (1) 3 members shall be officers, employees, or

24 designees of the Centers for Medicare & Medicaid

25 Services.
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1 (2) 4 members shall be national home health in2 dustry representatives.

3 (3) 4 members shall be patient advocates.

4 (c) DATE.—The Secretary shall appoint the members

5 of the OTF not later than the date that is 60 days after

6 the date of enactment of this Act.

7 (d) STUDY AND REPORT.—

8 (1) STUDY.—The OTF shall conduct a study

9 on the comprehensive assessment of patients to de10 termine whether—

11 (A) the number of assessments required

12 during an episode of care or the number of

13 questions asked during each assessment should

14 be decreased to eliminate redundant and

15 uninformative clinical information;

16 (B) a uniform data collection standard is

17 needed to ensure that patients who are not

18 medicare beneficiaries or medicaid beneficiaries

19 receive the same quality of care as patients who

20 are medicare beneficiaries or medicaid bene21 ficiaries; and

22 (C) OASIS data should be collected from

23 medicaid beneficiaries who are not medicare

24 beneficiaries.
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1 (2) REPORT.—Not later than the date that is

2 6 months after the date of enactment of this Act,

3 the OTF shall submit to the Secretary and Congress

4 a report on the study conducted under paragraph

5 (1), together with such recommendations for legisla6 tive or administrative action as the OTF determines

7 appropriate.

8 SEC. 5. ELIMINATION OF MANDATORY REQUIREMENT TO

9 COLLECT OUTCOMES ASSESSMENT AND IN10 FORMATION SET (OASIS) DATA FROM CER11 TAIN INDIVIDUALS.

12 Not later than the date that is 6 months after the

13 date of enactment of this Act, the Secretary shall promul14 gate a regulation revising the data collection requirements

15 under the Outcome and Assessment Information Set

16 (OASIS) standard that is used as part of the comprehen17 sive assessment of patients—

18 (1) to make the use of such data collection re19 quirements optional with respect to patients of home

20 health agencies who are not medicare beneficiaries

21 or medicaid beneficiaries; and

22 (2) to eliminate such data collection require23 ments with respect to any patient of a home health

24 agency to whom only personal care services are fur25 nished.
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1 SEC. 6. IMPROVING THE CLAIMS REVIEW PROCESS FOR DU2 ALLY-ELIGIBLE MEDICARE AND MEDICAID

3 BENEFICIARIES RECEIVING HOME HEALTH

4 SERVICES.

5 (a) IN GENERAL.—The Secretary shall review each

6 regulation relating to the demand billing process as such

7 process applies to individuals who are both medicare bene8 ficiaries and medicaid beneficiaries to determine whether

9 such processes may be conducted in a manner that—

10 (1) is efficient;

11 (2) allows for—

12 (A) the determination of coverage of home

13 health services under the medicare program

14 with respect to a patient not later than the date

15 that is 3 weeks after the date on which the pa16 tient is admitted to the home health agency;

17 and

18 (B) the expedient submission of a claim

19 prior to the end of an episode of care that

20 avoids the submission of a request for antici21 pated payment before a final payment deter22 mination is made; and

23 (3) does not adversely affect medicare bene24 ficiaries, medicaid beneficiaries, or home health

25 agencies in the determination of whether payment
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1 may be made under the medicare program for an

2 item or service furnished by a home health agency.

3 (b) IMPLEMENTATION.—Not later than the date that

4 is 6 months after the date of enactment of this Act, the

5 Secretary shall promulgate a final rule in accordance with

6 section 1871 of the Social Security Act (42 U.S.C.

7 1395hh) revising the processes described in subsection (a)

8 based on the review conducted under such subsection.

9 SEC. 7. CLAIMS REVIEW AND AUDIT TASK FORCE (CRATF).

10 (a) ESTABLISHMENT OF THE CLAIMS REVIEW AND

11 AUDIT TASK FORCE.—The Secretary shall establish the

12 Claims Review and Audit Task Force (in this section re13 ferred to as the ‘‘CRATF’’) in accordance with the provi14 sions of section 1114(f) of the Social Security Act (42

15 U.S.C. 1314(f)).

16 (b) MEMBERSHIP.—The CRATF shall be composed

17 of 11 members appointed by the Secretary as follows:

18 (1) 5 members shall be officers or employees of

19 the Centers for Medicare & Medicaid Services.

20 (2) 6 members shall be national home health in21 dustry representatives.

22 (c) DATE.—The Secretary shall appoint the members

23 of the CRATF not later than the date that is 60 days

24 after the date of enactment of this Act.

25 (d) STUDY AND REPORT.—
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1 (1) STUDY.—

2 (A) IN GENERAL.—The CRATF shall con3 duct a study on the processes and policies used

4 to review medical claims submitted by home

5 health agencies, technical denials of payment of

6 such claims, and the statistical sampling meth7 odology used to conduct post-payment audits

8 and reviews of such claims.

9 (B) SPECIFIC PROPOSALS CONSIDERED.—

10 In conducting the study under subparagraph

11 (A), the CRATF shall consider the following

12 proposals:

13 (i) Establishing reasonable time limits

14 on regional home health intermediaries for

15 review of claims.

16 (ii) Creating opportunities to use al17 ternative dispute resolution to resolve dis18 putes involving a claim for payment of a

19 home health agency.

20 (iii) Taking into account the results of

21 all past claim reviews and appeal deter22 minations to decide whether the provider

23 should be subject to the proposed audit.

24 (iv) Setting standards for responsible

25 and ethical home health agencies so that
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1 agencies that meet those standards would

2 be subject to a minimal number of sam3 pling audits, focused medical reviews, and

4 extensive prepayment claim reviews.

5 (v) The elimination of technical deni6 als of payment of claims submitted by

7 home health agencies.

8 (vi) Allowing the resubmission of any

9 technically noncompliant claim submitted

10 by a home health agency that has been

11 corrected so that such claim is a clean

12 claim.

13 (vii) Allowing physician assistants and

14 nurse practitioners to certify and make

15 changes to home health care plans to en16 sure that home health agencies will be re17 imbursed in a timely manner and that care

18 to the medicare beneficiary or medicaid

19 beneficiary would not be interrupted.

20 (viii) Developing a sampling regula21 tion through the rulemaking process de22 scribed in section 1871(b)(1) of the Social

23 Security Act (42 U.S.C. 1871(b)(1)).

24 (ix) Only using the methodology of

25 projecting overpayment to a provider of
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1 home health services from a sample of

2 claims where the Secretary has docu3 mented a widespread pattern of submitting

4 erroneous claims for payment by that pro5 vider for which payment is made under the

6 medicare program.

7 (2) REPORT.—Not later than the date that is

8 6 months after the date of enactment of this Act,

9 the CRATF shall submit to the Secretary and Con10 gress a report on the study conducted under para11 graph (1), together with such recommendations for

12 legislative or administrative action as the CRATF

13 determines appropriate.

14 SEC. 8. IMPLEMENTATION OF TASK FORCE RECOMMENDA15 TIONS.

16 (a) IMPLEMENTATION OF OTF RECOMMENDA17 TIONS.—Not later than the date that is 6 months after

18 the date on which the Secretary receives the report sub19 mitted under section 4(d)(2), the Secretary shall promul20 gate a regulation in accordance with section 1871 of the

21 Social Security Act (42 U.S.C. 1395hh) revising the regu22 lations relating to the comprehensive assessment of pa23 tients in order to implement the recommendations of the

24 OTF contained in such report.
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1 (b) IMPLEMENTATION OF CRATF RECOMMENDA2 TIONS.—Not later than the date that is 6 months after

3 the date on which the Secretary receives the report sub4 mitted under section 7(d)(2), the Secretary shall promul5 gate a regulation in accordance with section 1871 of the

6 Social Security Act (42 U.S.C. 1395hh) revising the regu7 lations relating to the processes and policies for review of

8 medical claims submitted by home health agencies, tech9 nical denials of payment of such claims, and the statistical

10 sampling methodology used to conduct post-payment au11 dits and reviews of such claims in order to implement the

12 recommendations of the CRATF contained in such report.

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