Medicare Skilled Nursing and Home Health Services Continuity of Care Act of 2015

To amend title XVIII of the Social Security Act to revise Medicare coverage and payment for advanced surgical dressings in skilled nursing facilities and home health settings, and for other purposes. 1. Short title; purpose (a) Short title This Act may be cited as the Medicare Skilled Nursing and Home Health Services Continuity of Care Act of 2015 (b) Purpose The purpose of this Act is to ensure Medicare beneficiary access to advance wound care products while in a skilled nursing facility or while on a home health plan of care by allowing separate payment to be made for advanced surgical dressings under part B of title XVIII of the Social Security Act as a durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) benefit. 2. Medicare coverage of and payment for advanced surgical dressings furnished in a skilled nursing facility or in a home health setting as durable medical equipment (a) Exclusion from payment as part of skilled nursing facility services Section 1888(e)(2)(A)(iii) of the Social Security Act ( 42 U.S.C. 1395yy(e)(2)(A)(iii) (VI) Surgical dressings (identified as most current of January 1, 2017, by HCPCS codes A4450–A6549, and as subsequently modified by the Secretary), if delivered to an individual who is a patient in a skilled nursing facility for use during the individual’s stay in the facility. . (b) Exclusion from coverage as part of home health services Section 1861(m)(5) of the Social Security Act ( 42 U.S.C. 1395x(m)(5) and durable medical equipment , durable medical equipment, and surgical dressings (identified as most current of January 1, 2017, by HCPCS codes A4450–A6549, and as subsequently modified by the Secretary) (c) Processing of claims for advanced surgical dressings Section 1874A(a) of the Social Security Act ( 42 U.S.C. 1395kk–1(a) (7) Use of medicare administrative contractors for processing claims for advanced surgical dressings The Secretary shall provide for the submission and processing of claims for surgical dressings referred to in sections 1888(e)(2)(A)(iii)(VI) and 1861(m)(5) for payment under part B by the same medicare administrative contractors as process claims for other durable medical equipment. . (d) Education incentive program To improve quality of wound care (1) In general The Secretary of Health and Human Services shall establish an education incentive program to encourage each nursing facility, skilled nursing facility, or home health agency certified under title XVIII or XIX of the Social Security Act to provide their clinical staff members annually with access to wound care education. Such education shall be of a scope and level to be determined by the Secretary. (2) Monitoring The Secretary shall establish a means of measuring such education on a regular basis, as determined by the Secretary. (3) Impact and incentives The Secretary shall determine the overall impact of the education incentive program on the quality of care provided. The type and level of incentive to be provided under the program shall be determined by the Secretary, in the Secretary’s discretion and subject to amounts available in advance from appropriations, based on the Secretary’s determination of such impact. (e) Effective date The amendments made by this section shall apply to surgical dressings furnished on or after January 1, 2017.

Summary: Medicare Skilled Nursing and Home Health Services Continuity of Care Act of 2015 This bill declares that its purpose is to ensure beneficiary access to advance wound care products while in a skilled nursing facility (SNF) or while on a home health plan of care by allowing separate payment to be made for advanced surgical dressings under part B of title XVIII (Medicare) of the Social Security Act as a durable medical equipment prosthetics, orthotics, and supplies benefit. To this end advanced surgical dressings are excluded from covered SNF services if delivered to a SNF patient for use during the SNF stay. Such dressings are included, however, as home health services. The Secretary of Health and Human Services is required to: (1) provide for the submission and processing of claims for advanced surgical dressings for payment under Medicare part B (Supplementary Medical Insurance) by the same Medicare administrative contractors that process claims for other durable medical equipment; and (2) establish an education incentive program to encourage each nursing facility, SNF, or home health agency certified under SSAct title XVIII or XIX (Medicaid) to provide their clinical staff members annually with access to wound care education.