I 
113TH CONGRESS 
1ST SESSION H. R. 3245 
To amend title XVIII of the Social Security Act to establish a maximum 
threshold for episode reimbursement to skilled home health agencies 
under Medicare. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 4, 2013 
Mr. MATHESON (for himself and Mr. GUTHRIE) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently 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 establish 
a maximum threshold for episode reimbursement to 
skilled home health agencies under Medicare. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Home Health 
Fraud Reduction Act’’. 
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SEC. 2. ESTABLISHMENT OF MAXIMUM THRESHOLD FOR 
EPISODE 
REIMBURSEMENT 
TO 
SKILLED 
HOME HEALTH AGENCIES UNDER MEDICARE. 
Section 1895(b) of the Social Security Act (42 U.S.C. 
1395fff(b)) is amended by adding at the end the following 
new paragraph: 
‘‘(7) EPISODE UTILIZATION RATE.— 
‘‘(A) PAYMENT
LIMITATION.—For 2014 
and each subsequent year, payment may not be 
made to a skilled home health agency under 
this section for an episode of care to the extent 
that such episode exceeds the applicable episode 
utilization limit established under subparagraph 
(B) for the agency for the year. 
‘‘(B) APPLICABLE
EPISODE
UTILIZATION 
LIMIT.— 
‘‘(i) IN
GENERAL.—For 2014 and 
each subsequent year, the Secretary shall 
establish an episode utilization limit for a 
skilled home health agency that is equal to 
the product of— 
‘‘(I) in the case of a skilled home 
health agency located in— 
‘‘(aa) a rural area, 3.3 epi-
sodes; and 
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‘‘(bb) in an area not de-
scribed in item (aa), 2.7 episodes; 
and 
‘‘(II) the total number of Medi-
care beneficiaries for the skilled home 
health agency (as defined in clause 
(iii)). 
‘‘(ii) EPISODE
DEFINED.—For pur-
poses of this paragraph, the term ‘episode’ 
has the meaning given such term for pur-
poses of section 484.205 of title 42, Code 
of Federal Regulations (as in effect on Oc-
tober 1, 2011) and includes partial epi-
sodes for which a partial episode payment 
is made pursuant to such section to the ex-
tent such partial episode is a percentage of 
a full episode. 
‘‘(iii) TOTAL NUMBER OF MEDICARE 
BENEFICIARIES DEFINED.— 
‘‘(I) IN GENERAL.—For purposes 
of clause (i)(II), the term ‘total num-
ber of Medicare beneficiaries’ means, 
with respect to a skilled home health 
agency and year, the total number of 
unduplicated individuals who were 
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furnished home health services under 
this title in the year by the agency. 
‘‘(II) SPECIAL RULE.—In calcu-
lating the total number of Medicare 
beneficiaries under subclause (I), in 
any case where an individual is fur-
nished skilled home health care serv-
ices from more than one agency, the 
number of such individuals being 
counted toward the applicable episode 
utilization limit for each such agency 
shall be proportionally credited in an 
amount equal to the percentage of the 
total number of episodes provided by 
the agency.’’. 
Æ 
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