Title: Home Health Documentation and Program Improvement Act of 2017
Policy area: Health

Summary:
Home Health Documentation and Program Improvement Act of 2017
This bill requires the Centers for Medicare & Medicaid Services (CMS) to use an individual's medical record from a home-health agency, as appropriate, to support certification of such individual's Medicare eligibility for home-health services.
The bill requires the CMS to establish a process for home-health agencies that are entitled to an administrative appeal after being denied eligibility for Medicare reimbursement to, instead, enter into a settlement with the CMS.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2663 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 2663

  To amend title XVIII of the Social Security Act to make changes to 
documentation of eligibility for Medicare home health services, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 25, 2017

Mr. Marchant (for himself and Mr. Blumenauer) introduced the following 
  bill; which was referred to the Committee on Ways and Means, and in 
 addition to the Committee on Energy and Commerce, for a period to be 
subsequently 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 make changes to 
documentation of eligibility for Medicare home health services, and for 
                            other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Home Health Documentation and 
Program Improvement Act of 2017''.

SEC. 2. INFORMATION TO SATISFY DOCUMENTATION OF MEDICARE ELIGIBILITY 
              FOR HOME HEALTH SERVICES.

    (a) Part A.--Section 1814(a) of the Social Security Act (42 U.S.C. 
1395f(a)) is amended by inserting before ``For purposes of paragraph 
(2)(C),'' the following new sentence: ``For purposes of documentation 
for physician certification and recertification made under paragraph 
(2) on or after January 1, 2018, and made with respect to home health 
services furnished by a home health agency, in addition to using 
documentation in the medical record of the physician who so certifies 
or the medical record of the acute or post-acute care facility (in the 
case that home health services were furnished to an individual who was 
directly admitted to the home health agency from such a facility), the 
Secretary shall use documentation in the medical record of the home 
health agency as supporting material, as appropriate to the case 
involved.''.
    (b) Part B.--Section 1835(a) of the Social Security Act (42 U.S.C. 
1395n(a)) is amended by inserting before ``For purposes of paragraph 
(2)(A),'' the following new sentence: ``For purposes of documentation 
for physician certification and recertification made under paragraph 
(2) on or after January 1, 2018, and made with respect to home health 
services furnished by a home health agency, in addition to using 
documentation in the medical record of the physician who so certifies 
or the medical record of the acute or post-acute care facility (in the 
case that home health services were furnished to an individual who was 
directly admitted to the home health agency from such a facility), the 
Secretary shall use documentation in the medical record of the home 
health agency as supporting material, as appropriate to the case 
involved.''.

SEC. 3. VOLUNTARY SETTLEMENT OF HOME HEALTH CLAIMS.

    (a) Settlement Process for Home Health Claims.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall establish a settlement process under which a 
        home health agency entitled to an eligible administrative 
        appeal has the option to enter into a settlement with the 
        Secretary that is reached in a manner consistent with the 
        succeeding paragraphs of this subsection.
            (2) Process and consideration of home health claims.--A 
        settlement under paragraph (1) with a home health agency that 
        is with respect to an eligible administrative appeal may only 
        be reached in accordance with the following process:
                    (A) A settlement under such paragraph with the home 
                health agency shall be with respect to all claims by 
                such agency, subject to paragraph (4), that, as of the 
                date of such settlement, are under an eligible 
                administrative appeal.
                    (B) For the duration of the settlement process with 
                such agency, an eligible administrative appeal that is 
                with respect to any such claim by such agency shall be 
                suspended.
                    (C) Under the settlement process, the Secretary 
                shall determine an aggregate amount to be paid to the 
                home health agency with respect to all claims by such 
                agency that are under an eligible administrative appeal 
                in the following manner:
                            (i) The Secretary shall, for purposes of 
                        applying clause (ii) with respect to all 
                        settlements under paragraph (1), select a 
                        percentage. In selecting such percentage, the 
                        Secretary shall consider the percentage used 
                        under the Centers for Medicare & Medicaid 
                        Services hospital appeals settlement that began 
                        on October 31, 2014.
                            (ii) The Secretary shall, with respect to 
                        each denied claim for such agency that is under 
                        an eligible administrative appeal, calculate an 
                        amount (referred to in this subparagraph as an 
                        ``individual claim amount'') by multiplying the 
                        net payable amount for such claim by the 
                        percentage selected under clause (i).
                            (iii) Such aggregate amount with respect to 
                        such agency shall be determined by calculating 
                        the total sum of all the individual claim 
                        amounts calculated under clause (ii) with 
                        respect to such agency.
            (3) Effect of process.--
                    (A) Effect of settlement.--
                            (i) Further appeal.--As part of any 
                        settlement under paragraph (1) between a home 
                        health agency and the Secretary, such home 
                        health agency shall be required to forego the 
                        right to an administrative appeal under section 
                        1869 of the Social Security Act (42 U.S.C. 
                        1395ff) or section 1878 of such Act (42 U.S.C. 
                        1395oo) (including any redetermination, 
                        reconsideration, hearing, or review) with 
                        respect to any claims for home health services 
                        that are subject to the settlement.
                            (ii) Judicial review.--There shall be no 
                        administrative or judicial review under such 
                        section 1869 or otherwise of a settlement under 
                        paragraph (1) and the claims covered by the 
                        settlement.
                    (B) Effect of no settlement.--In the event that the 
                process described in paragraph (2) does not, with 
                respect to a home health agency, result in a settlement 
                under paragraph (1) with such agency, any appeal under 
                such section 1869 that is with respect to a claim by 
                such agency that was suspended pursuant to paragraph 
                (2)(B) shall resume under such section.
            (4) Coordination with law enforcement.--The Secretary of 
        Health and Human Services shall establish a process under which 
        individuals in the Department of Health and Human Services 
        responsible for executing a settlement under paragraph (1) may, 
        in order to avoid the inadvertent settlement of cases that 
        involve fraud or other criminal activity, coordinate with 
        appropriate law enforcement agencies.
    (b) No Entitlement to Settlement Process.--Nothing in this section 
shall be construed as creating an entitlement to enter into a 
settlement process established pursuant to subsection (a).
    (c) Eligible Administrative Appeal Defined.--For purposes of this 
section, the term ``eligible administrative appeal'' means an appeal 
under section 1869 of the Social Security Act (42 U.S.C. 1395ff) 
(including any redetermination, reconsideration, hearing, or review)--
            (1) that is with respect to one or more claims that--
                    (A) are for home health services that--
                            (i) were furnished on or after January 1, 
                        2011, and before January 1, 2015; and
                            (ii) were reasonable and necessary under 
                        section 1862(a)(1)(A) of such Act (42 U.S.C. 
                        1395y(a)(1)(A)); and
                    (B) were timely filed consistent with section 
                1814(a)(1) of such Act (42 U.S.C. 1395f(a)(1)) or 
                sections 1835(a)(1) and 1842(b)(3) of such Act (42 
                U.S.C. 1395n(a)(1), 1395u(b)(3)); and
            (2) either--
                    (A) was timely filed consistent with section 1869 
                of such Act (42 U.S.C. 1395ff) and is pending; or
                    (B) for which the applicable time frame to file an 
                appeal has not expired.
    (d) Conforming Amendment.--Section 1869 of the Social Security Act 
(42 U.S.C. 1395ff) is amended by adding at the end the following new 
subsection:
    ``(j) Application With Respect to Certain Home Health Claims.--For 
the application of the provisions of this section with respect to 
certain claims for home health services that were furnished on or after 
January 1, 2011, and before January 1, 2015, see section 3 of the Home 
Health Documentation and Program Improvement Act of 2017.''.
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