[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1169 Introduced in Senate (IS)]
107th CONGRESS
1st Session
S. 1169
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 SENATE OF THE UNITED STATES
July 12, 2001
Mr. Feingold (for himself, Mr. Murkowski, Ms. Collins, and Mr. Kerry)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
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 2001''.
(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 Senate 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 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 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
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 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 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 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.
<all>