(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
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.
SEC. 2. FINDINGS.
The Congress makes the following findings:
(1) The Outcomes Assessment and Information
Set (in this section referred to as ‘‘OASIS’’) includes
information regarding the health and functional sta-
tus of patients of home health agencies, the use of
health services by such patients, the living conditions
of such patients, and the social support provided to
such patients, that is necessary to assess the quality
of care being provided to medicare and medicaid pa-
tients by home health agencies.
(2) According to the Comptroller General of the
United States, the average additional time that is
necessary for a home health agency to comply with
the OASIS requirement for a start-of-care assess-
ment is 61 minutes more than the amount of time
to comply with such requirement estimated by the
Centers for Medicare & Medicaid Services.
(3) Existing Federal regulations and associated
paperwork requirements are excessively straining
home health agencies and their clinical staff, and are
often reported by nurses to be the primary contribu-
tors to their decreased job satisfaction.
(4) Many nurses and home health aides are
leaving the home health care profession and patients
are staying in the hospital longer than necessary.
(5) A 2000 national survey of home health
agencies by the Hospital and Healthcare Compensa-
tion Service reported a 21 percent turnover rate for
registered nurses, a 24 percent turnover rate for li-
censed practical nurses, and a 28 percent turnover
rate for home health aides.
(6) In its May 17, 2001 report titled ‘‘Nursing
Workforce—Recruitment and Retention of Nurses
and Nurse Aides Is a Growing Concern’’, the Gen-
eral Accounting Office reported that the jobs for
nurse aides working in home health care are pro-
jected to increase by 58 percent, from 746,000 in
1998 to 1,200,000 in 2008.
SEC. 3. DEFINITIONS.
In this Act:
(1) COMPREHENSIVE
ASSESSMENT
OF
PA-
TIENTS.—The term ‘‘comprehensive assessment of
patients’’ means the rule published by the Centers
for Medicare & Medicaid Services that requires, as
a condition of participation in the medicare pro-
gram, a home health agency to provide a patient-
specific comprehensive assessment that accurately
reflects the patient’s current status and that incor-
porates the Outcome and Assessment Information
Set (OASIS).
(2) CRATF.—The term ‘‘CRATF’’ means the
Claims Review and Audit Task Force established
under section 7.
(3) HOME HEALTH AGENCY.—The term ‘‘home
health agency’’ has the meaning given that term
under section 1861(o) of the Social Security Act (42
U.S.C. 1395x(o)).
(4) OUTCOME AND ASSESSMENT INFORMATION
SET; OASIS.—The terms ‘‘Outcome and Assessment
Information Set’’ and ‘‘OASIS’’ mean the standard
provided under the rule relating to data items that
must be used in conducting a comprehensive assess-
ment of patients.
(5) MEDICAID BENEFICIARY.—The term ‘‘med-
icaid beneficiary’’ means an individual who is eligible
for medical assistance under a State plan under the
medicaid program under title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.).
(6) 
MEDICARE
BENEFICIARY.—The 
term
‘‘medicare beneficiary’’ means an individual who is
entitled to benefits under part A of title XVIII of
the Social Security Act (42 U.S.C. 1395c et seq.) or
enrolled under part B of such title (42 U.S.C. 1395j
et seq.), including an individual who is enrolled in a
Medicare+Choice plan under part C of such title
(42 U.S.C. 1395w–21 et seq.).
(7) OTF.—The term ‘‘OTF’’ means the OASIS
Task Force established under section 4.
(8) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services, acting
through the Administrator of the Centers for Medi-
care & Medicaid Services.
SEC. 4. OASIS TASK FORCE (OTF).
(a) ESTABLISHMENT OF THE OASIS TASK FORCE.—
The Secretary shall establish the OASIS Task Force (in
this section referred to as the ‘‘OTF’’) in accordance with
the provisions of section 1114(f) of the Social Security Act
(42 U.S.C. 1314(f)).
(b) MEMBERSHIP.—The OTF shall be composed of
11 members appointed by the Secretary as follows:
(1) 3 members shall be officers, employees, or
designees of the Centers for Medicare & Medicaid
Services.
(2) 4 members shall be national home health in-
dustry representatives.
(3) 4 members shall be patient advocates.
(c) DATE.—The Secretary shall appoint the members
of the OTF not later than the date that is 60 days after
the date of the enactment of this Act.
(d) STUDY AND REPORT.—
(1) STUDY.—The OTF shall conduct a study
on the comprehensive assessment of patients to de-
termine whether—
(A) the number of assessments required
during an episode of care or the number of
questions asked during each assessment should
be decreased to eliminate redundant and
uninformative clinical information;
(B) a uniform data collection standard is
needed to ensure that patients who are not
medicare beneficiaries or medicaid beneficiaries
receive the same quality of care as patients who
are medicare beneficiaries or medicaid bene-
ficiaries; and
(C) OASIS data should be collected from
medicaid beneficiaries who are not medicare
beneficiaries.
(2) REPORT.—Not later than the date that is
6 months after the date of the enactment of this
Act, the OTF shall submit to the Secretary and
Congress a report on the study conducted under
paragraph (1), together with such recommendations
for legislative or administrative action as the OTF
determines appropriate.
SEC. 5. ELIMINATION OF MANDATORY REQUIREMENT TO
COLLECT OUTCOMES ASSESSMENT AND IN-
FORMATION SET (OASIS) DATA FROM CER-
TAIN INDIVIDUALS.
Not later than the date that is 6 months after the
date of the enactment of this Act, the Secretary shall pro-
mulgate a regulation revising the data collection require-
ments under the Outcome and Assessment Information
Set (OASIS) standard that is used as part of the com-
prehensive assessment of patients—
(1) to make the use of such data collection re-
quirements optional with respect to patients of home
health agencies who are not medicare beneficiaries
or medicaid beneficiaries; and
(2) to eliminate such data collection require-
ments with respect to any patient of a home health
agency to whom only personal care services are fur-
nished.
SEC. 6. IMPROVING THE CLAIMS REVIEW PROCESS FOR DU-
ALLY-ELIGIBLE MEDICARE AND MEDICAID
BENEFICIARIES RECEIVING HOME HEALTH
SERVICES.
(a) IN GENERAL.—The Secretary shall review each
regulation relating to the demand billing process as such
process applies to individuals who are both medicare bene-
ficiaries and medicaid beneficiaries to determine whether
such processes may be conducted in a manner that—
(1) is efficient;
(2) allows for—
(A) the determination of coverage of home
health services under the medicare program
with respect to a patient not later than the date
that is 3 weeks after the date on which the pa-
tient is admitted to the home health agency;
and
(B) the expedient submission of a claim
prior to the end of an episode of care that
avoids the submission of a request for antici-
pated payment before a final payment deter-
mination is made; and
(3) does not adversely affect medicare bene-
ficiaries, medicaid beneficiaries, or home health
agencies in the determination of whether payment
may be made under the medicare program for an
item or service furnished by a home health agency.
(b) IMPLEMENTATION.—Not later than the date that
is 6 months after the date of the enactment of this Act,
the Secretary shall promulgate a final rule in accordance
with section 1871 of the Social Security Act (42 U.S.C.
1395hh) revising the processes described in subsection (a)
based on the review conducted under such subsection.
SEC. 7. CLAIMS REVIEW AND AUDIT TASK FORCE (CRATF).
(a) ESTABLISHMENT OF THE CLAIMS REVIEW AND
AUDIT TASK FORCE.—The Secretary shall establish the
Claims Review and Audit Task Force (in this section re-
ferred to as the ‘‘CRATF’’) in accordance with the provi-
sions of section 1114(f) of the Social Security Act (42
U.S.C. 1314(f)).
(b) MEMBERSHIP.—The CRATF shall be composed
of 11 members appointed by the Secretary as follows:
(1) 5 members shall be officers or employees of
the Centers for Medicare & Medicaid Services.
(2) 6 members shall be national home health in-
dustry representatives.
(c) DATE.—The Secretary shall appoint the members
of the CRATF not later than the date that is 60 days
after the date of the enactment of this Act.
(d) STUDY AND REPORT.—
(1) STUDY.—
(A) IN GENERAL.—The CRATF shall con-
duct a study on the processes and policies used
to review medical claims submitted by home
health agencies, technical denials of payment of
such claims, and the statistical sampling meth-
odology used to conduct post-payment audits
and reviews of such claims.
(B) SPECIFIC PROPOSALS CONSIDERED.—
In conducting the study under subparagraph
(A), the CRATF shall consider the following
proposals:
(i) Establishing reasonable time limits
on regional home health intermediaries for
review of claims.
(ii) Creating opportunities to use al-
ternative dispute resolution to resolve dis-
putes involving a claim for payment of a
home health agency.
(iii) Taking into account the results of
all past claim reviews and appeal deter-
minations to decide whether the provider
should be subject to the proposed audit.
(iv) Setting standards for responsible
and ethical home health agencies so that
agencies that meet those standards would
be subject to a minimal number of sam-
pling audits, focused medical reviews, and
extensive prepayment claim reviews.
(v) The elimination of technical deni-
als of payment of claims submitted by
home health agencies.
(vi) Allowing the resubmission of any
technically noncompliant claim submitted
by a home health agency that has been
corrected so that such claim is a clean
claim.
(vii) Allowing physician assistants and
nurse practitioners to certify and make
changes to home health care plans to en-
sure that home health agencies will be re-
imbursed in a timely manner and that care
to the medicare beneficiary or medicaid
beneficiary would not be interrupted.
(viii) Developing a sampling regula-
tion through the rulemaking process de-
scribed in section 1871(b)(1) of the Social
Security Act (42 U.S.C. 1871(b)(1)).
(ix) Only using the methodology of
projecting overpayment to a provider of
home health services from a sample of
claims where the Secretary has docu-
mented a widespread pattern of submitting
erroneous claims for payment by that pro-
vider for which payment is made under the
medicare program.
(2) REPORT.—Not later than the date that is
6 months after the date of the enactment of this
Act, the CRATF shall submit to the Secretary and
Congress a report on the study conducted under
paragraph (1), together with such recommendations
for legislative or administrative action as the
CRATF determines appropriate.
SEC. 8. IMPLEMENTATION OF TASK FORCE RECOMMENDA-
TIONS.
(a) IMPLEMENTATION
OF
OTF RECOMMENDA-
TIONS.—Not later than the date that is 6 months after
the date on which the Secretary receives the report sub-
mitted under section 4(d)(2), the Secretary shall promul-
gate a regulation in accordance with section 1871 of the
Social Security Act (42 U.S.C. 1395hh) revising the regu-
lations relating to the comprehensive assessment of pa-
tients in order to implement the recommendations of the
OTF contained in such report.
(b) IMPLEMENTATION
OF CRATF RECOMMENDA-
TIONS.—Not later than the date that is 6 months after
the date on which the Secretary receives the report sub-
mitted under section 7(d)(2), the Secretary shall promul-
gate a regulation in accordance with section 1871 of the
Social Security Act (42 U.S.C. 1395hh) revising the regu-
lations relating to the processes and policies for review of
medical claims submitted by home health agencies, tech-
nical denials of payment of such claims, and the statistical
sampling methodology used to conduct post-payment au-
dits and reviews of such claims in order to implement the
recommendations of the CRATF contained in such report.
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