[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3245 Introduced in House (IH)]

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 
 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 establish a maximum 
  threshold for episode reimbursement to skilled home health agencies 
                            under Medicare.

    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 ``Medicare Home Health Fraud Reduction 
Act''.

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 
                                        episodes; and
                                            ``(bb) in an area not 
                                        described in item (aa), 2.7 
                                        episodes; and
                                    ``(II) the total number of Medicare 
                                beneficiaries for the skilled home 
                                health agency (as defined in clause 
                                (iii)).
                            ``(ii) Episode defined.--For purposes of 
                        this paragraph, the term `episode' has the 
                        meaning given such term for purposes of section 
                        484.205 of title 42, Code of Federal 
                        Regulations (as in effect on October 1, 2011) 
                        and includes partial episodes for which a 
                        partial episode payment is made pursuant to 
                        such section to the extent 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 number 
                                of Medicare beneficiaries' means, with 
                                respect to a skilled home health agency 
                                and year, the total number of 
                                unduplicated individuals who were 
                                furnished home health services under 
                                this title in the year by the agency.
                                    ``(II) Special rule.--In 
                                calculating the total number of 
                                Medicare beneficiaries under subclause 
                                (I), in any case where an individual is 
                                furnished skilled home health care 
                                services 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.''.
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