II 

114TH CONGRESS 

1ST SESSION S. 1650 

To amend title XVIII of the Social Security Act to make changes to the 

Medicare home health face-to-face encounter requirements. 

IN THE SENATE OF THE UNITED STATES 

JUNE 23, 2015 

Mr. MENENDEZ (for himself and Mr. ROBERTS) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to make 

changes to the Medicare home health face-to-face encounter requirements. 

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. 

4 This Act may be cited as the ‘‘Home Health Docu5 mentation and Program Improvement Act of 2015’’. 

6 SEC. 2. DEVELOPMENT OF A SINGLE FORM OR DOCUMENT 

7 TO SATISFY THE HOME HEALTH CERTIFI8 CATION REQUIREMENT. 

9 (a) PART A.—Section 1814 of the Social Security Act 

10 (42 U.S.C. 1395f) is amended— 


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1 (1) in subsection (a)(2)(C), by striking ‘‘has 

2 had a face-to-face encounter’’ and inserting ‘‘has, 

3 subject to subsection (m), had a face-to-face encoun4 ter’’; and 

5 (2) by adding at the end the following new sub6 section: 

7 ‘‘(m) IMPLEMENTATION OF REQUIREMENT FOR CER8 TIFICATION FOR HOME HEALTH SERVICES.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall develop 

10 a single form or document to be used by a physician 

11 to satisfy the documentation requirements necessary 

12 to fulfill the requirement of a face-to-face encounter 

13 and other criteria for home health eligibility under 

14 subsection (a)(2)(C) (otherwise known as the certifi15 cation for home health services). 

16 ‘‘(2) STAKEHOLDER INPUT.—In developing the 

17 form or document under paragraph (1), the Sec18 retary shall seek input from stakeholders, including 

19 physicians and other non-physician providers (such 

20 as nurse practitioners or clinical nurse specialists (as 

21 those terms are defined in section 1861(aa)(5))), 

22 home health agencies, hospitals, patients or rep23 resentatives of patients, and other entities (such as 

24 electronic medical record vendors) the Secretary de25 termines appropriate. The Secretary shall provide 


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1 the opportunity for such stakeholders to offer input 

2 on the form or document during its initial develop3 ment as well as the opportunity to make comments 

4 on a proposed version prior to its finalization. The 

5 Secretary shall also set up a process to educate phy6 sicians and non-physicians on how to appropriately 

7 fulfill the requirements related to the form or docu8 ment in this section prior to implementation. 

9 ‘‘(3) CONTENT OF FORM.—The Secretary shall 

10 accept the following content as documentation of an 

11 individual’s eligibility for home health services: 

12 ‘‘(A) With respect to the face-to-face en13 counter requirement, the date of the encounter. 

14 ‘‘(B) With respect to homebound status, a 

15 statement that provides the clinical basis for 

16 why the individual is determined to be confined 

17 to the home. 

18 ‘‘(C) With respect to the need for skilled 

19 services, a selection, via checkbox, of the types 

20 of skilled services required by the individual and 

21 a statement with the clinical basis for each type 

22 of skilled service ordered. 

23 ‘‘(4) DEEMED SATISFACTION OF REQUIRE24 MENTS.—The Secretary shall, through guidance, 

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1 to-face encounter and other criteria for home health 

2 eligibility under subsection (a)(2)(C) to be deemed 

3 satisfied with respect to an individual if a home 

4 health agency completes the form or document under 

5 paragraph (1) and the ordering physician signs or 

6 attests to the contents of the form or document. 

7 ‘‘(5) EXCEPTION TO FACE-TO-FACE ENCOUN8 TER REQUIREMENT.—The Secretary shall waive the 

9 requirement for a face-to-face encounter under sub10 section (a)(2)(C) related to home health services 

11 provided to an individual if the individual has been 

12 discharged from a hospital (including from the emer13 gency department) or skilled nursing facility within 

14 14 days prior to the initiation of such home health 

15 services. 

16 ‘‘(6) GUIDANCE TO CONTRACTORS.— 

17 ‘‘(A) IN GENERAL.—The Secretary shall 

18 provide notification, guidance, and education re19 garding the application of the form or docu20 ment under paragraph (1) as it pertains to sat21 isfying the documentation requirements for 

22 home health services under subsection (a)(2)(C) 

23 to medicare administrative contractors (as de24 fined in section 1874A), recovery audit contrac25 tors (as defined in section 1893(h)), and any 


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1 other entity which the Secretary determines ap2 propriate. 

3 ‘‘(B) NATIONAL APPLICABILITY.—The 

4 Secretary shall ensure that all medicare admin5 istrative contractors, recovery audit contractors, 

6 and any other entity which the Secretary deter7 mines appropriate apply the guidance under 

8 this paragraph in a nationally consistent and 

9 uniform manner and that all audit activities, 

10 policies, and practices regarding documentation 

11 for home health services are likewise applied in 

12 a nationally consistent and uniform manner. 

13 ‘‘(C) STUDY.—Not later than 18 months 

14 after the date of the enactment of this para15 graph, the Secretary shall submit to Congress a 

16 report on— 

17 ‘‘(i) the adherence of medicare admin18 istrative contractors, recovery audit con19 tractors, and any other entity which the 

20 Secretary determines appropriate to na21 tionally consistent and uniform audit ac22 tivities, policies, and practices as described 

23 in subparagraph (B); and 

24 ‘‘(ii) the rate of appeals for denial of 

25 payment based solely on the face-to-face 


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1 encounter requirements for home health 

2 services under this section and the rate of 

3 such appeals that are ultimately success4 ful.’’. 

5 (b) PART B.—Section 1835 of the Social Security Act 

6 (42 U.S.C. 1395n) is amended— 

7 (1) in subsection (a)(2)(A), by striking ‘‘has 

8 had a face-to-face encounter’’ and inserting ‘‘has, 

9 subject to subsection (f), had a face-to-face encoun10 ter’’; and 

11 (2) by adding at the end the following new sub12 section: 

13 ‘‘(f) APPLICATION OF DOCUMENTATION, GUIDANCE, 

14 AND TREATMENT OF CERTAIN HOME HEALTH CLAIMS

15 PROVISIONS UNDER PART A.—The provisions of section 

16 1814(m) shall apply with respect to the application of doc17 umentation requirements for home health services under 

18 subsection (a)(2)(A) in the same manner as such provi19 sions apply with respect to the application of the docu20 mentation requirements for home health services under 

21 section 1814(a)(2)(C).’’. 


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1 SEC. 3. EFFECTIVE DATE; TREATMENT OF CERTAIN HOME 

2 HEALTH CLAIMS. 

3 (a) EFFECTIVE DATE.—The amendments made by 

4 section 2 shall apply with respect to home health services 

5 furnished on or after October 1, 2016. 

6 (b) TREATMENT OF CERTAIN HOME HEALTH

7 CLAIMS.— 

8 (1) DENIED CLAIMS.— 

9 (A) IN GENERAL.—Not later than 12 

10 months after the date of the enactment of this 

11 Act, the Secretary of Health and Human Serv12 ices shall— 

13 (i) through guidance, develop and im14 plement processes to open and review 

15 claims that were denied on or after Janu16 ary 1, 2011, and before the date of the en17 actment of this Act, due solely to the face18 to-face documentation requirements under 

19 section 1814(a)(2)(C) of the Social Secu20 rity Act (42 U.S.C. 1395f(a)(2)(C)) or sec21 tion 1835(a)(2)(A) of such Act (42 U.S.C. 

22 1395f(a)(2)(A)); and 

23 (ii) issue revised decisions of such de24 nials as if the narrative requirements of 

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1 eral Regulations, did not apply at the time 

2 such services were furnished. 

3 (B) SETTLEMENT AGREEMENTS FOR DE4 NIED CLAIMS.—In addition to the processes 

5 under subparagraph (A), not later than 60 days 

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

7 Secretary shall establish a voluntary process for 

8 home health agencies to enter into a settlement 

9 agreement with the Secretary of Health and 

10 Human Services in lieu of reprocessing claims 

11 for payment which are required to be paid by 

12 reason of subparagraph (A)(ii). 

13 (2) OTHER CLAIMS.—In the case of a claim for 

14 home health services furnished on or after January 

15 1, 2011, and before October 1, 2016, that is not de16 scribed in paragraph (1)(A), such claim shall be de17 termined and processed as if the narrative require18 ments of section 424.22(v) of title 42, Code of Fed19 eral Regulations, did not apply at the time such 

20 services were furnished. 

Æ 


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