[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4659 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 4659

   To streamline the regulatory processes applicable to home health 
  agencies under the Medicare Program under title XVIII of the Social 
Security Act and the Medicaid Program under title XIX of such Act, and 
                          for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 2, 2002

  Mr. Sununu 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 streamline the regulatory processes applicable to home health 
  agencies under the Medicare Program under title XVIII of the Social 
Security Act and the Medicaid Program under title XIX of such Act, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Home Health Nurse 
and Patient Act of 2002''.
    (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 status 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 
        patients 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 assessment 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 contributors 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 Compensation Service reported a 21 
        percent turnover rate for registered nurses, a 24 percent 
        turnover rate for licensed 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 General Accounting Office reported that 
        the jobs for nurse aides working in home health care are 
        projected 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 patients.--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 
        program, a home health agency to provide a patient-specific 
        comprehensive assessment that accurately reflects the patient's 
        current status and that incorporates 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 
        assessment of patients.
            (5) Medicaid beneficiary.--The term ``medicaid 
        beneficiary'' means an individual who is eligible for medical 
        assistance under a State plan under the medicaid program under 
        title XIX of the Social Security 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 Medicare & 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 industry 
        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 determine 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 beneficiaries; 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 INFORMATION SET (OASIS) DATA FROM CERTAIN 
              INDIVIDUALS.

    Not later than the date that is 6 months after the date of the 
enactment of this Act, the Secretary shall promulgate a regulation 
revising the data collection requirements under the Outcome and 
Assessment Information Set (OASIS) standard that is used as part of the 
comprehensive assessment of patients--
            (1) to make the use of such data collection requirements 
        optional with respect to patients of home health agencies who 
        are not medicare beneficiaries or medicaid beneficiaries; and
            (2) to eliminate such data collection requirements with 
        respect to any patient of a home health agency to whom only 
        personal care services are furnished.

SEC. 6. IMPROVING THE CLAIMS REVIEW PROCESS FOR DUALLY-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 beneficiaries 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 patient 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 anticipated payment before 
                a final payment determination is made; and
            (3) does not adversely affect medicare beneficiaries, 
        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 referred to as the ``CRATF'') in accordance with the 
provisions 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 industry 
        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 conduct 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 methodology 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 
                        alternative dispute resolution to resolve 
                        disputes involving a claim for payment of a 
                        home health agency.
                            (iii) Taking into account the results of 
                        all past claim reviews and appeal 
                        determinations 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 sampling audits, focused 
                        medical reviews, and extensive prepayment claim 
                        reviews.
                            (v) The elimination of technical denials 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 ensure that home 
                        health agencies will be reimbursed in a timely 
                        manner and that care to the medicare 
                        beneficiary or medicaid beneficiary would not 
                        be interrupted.
                            (viii) Developing a sampling regulation 
                        through the rulemaking process described 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 documented a widespread 
                        pattern of submitting erroneous claims for 
                        payment by that provider 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 RECOMMENDATIONS.

    (a) Implementation of OTF Recommendations.--Not later than the date 
that is 6 months after the date on which the Secretary receives the 
report submitted under section 4(d)(2), the Secretary shall promulgate 
a regulation in accordance with section 1871 of the Social Security Act 
(42 U.S.C. 1395hh) revising the regulations relating to the 
comprehensive assessment of patients in order to implement the 
recommendations of the OTF contained in such report.
    (b) Implementation of CRATF Recommendations.--Not later than the 
date that is 6 months after the date on which the Secretary receives 
the report submitted under section 7(d)(2), the Secretary shall 
promulgate a regulation in accordance with section 1871 of the Social 
Security Act (42 U.S.C. 1395hh) revising the regulations relating to 
the processes and policies for review of medical claims submitted by 
home health agencies, technical denials of payment of such claims, and 
the statistical sampling methodology used to conduct post-payment 
audits and reviews of such claims in order to implement the 
recommendations of the CRATF contained in such report.
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