[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6226 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 6226

To delay the Medicare demonstration for pre-claim review of home health 
                   services, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 28, 2016

Mr. Tom Price of Georgia (for himself, Mr. McGovern, Mr. Marchant, Mr. 
 Thornberry, and Mr. Gohmert) 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 delay the Medicare demonstration for pre-claim review of 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 ``Pre-Claims Undermine Seniors' Health 
Act of 2016'' or the ``PUSH Act of 2016''.

SEC. 2. DELAY IN THE MEDICARE DEMONSTRATION FOR PRE-CLAIM REVIEW OF 
              HOME HEALTH SERVICES.

    (a) In General.--In the case of the demonstration for pre-claim 
review for home health services furnished under title XVIII of the 
Social Security Act for operation in 5 States under section 
402(a)(1)(J) of the Social Security Amendments of 1967 (42 U.S.C. 
1395b-1(a)(1)(J)), as announced in the Federal Register on June 10, 
2016 (81 Fed. Reg. 37598)--
            (1) in the case of any of such 5 States in which the 
        demonstration began operation before the date of the enactment 
        of this section, the Secretary of Health and Human Services 
        shall suspend the operation of the demonstration in such State 
        so it does not apply to episodes of care beginning earlier than 
        the later of--
                    (A) 1 year after such date of enactment; or
                    (B) 6 months after the date that the Congress 
                receives the report submitted under subsection (b);
            (2) in the case of any of such 5 States not described in 
        paragraph (1), the Secretary shall delay any operation of the 
        demonstration in each State so it does not apply to episodes of 
        care beginning earlier than the later of--
                    (A) 1 year after the earliest date that such 
                demonstration was scheduled to begin operation in the 
                State as so announced; or
                    (B) 6 months after the date the Congress receives 
                such report; and
            (3) in the case of a State not described in paragraph (1) 
        or (2), the Secretary shall not begin operation of such a 
        demonstration in the State until at least the later of--
                    (A) 1 year after such date of enactment; or
                    (B) 6 months after the date that the Congress 
                receives such report.
    (b) Report.--Not later than 1 year after the date of the enactment 
of this Act, the Secretary shall submit a report to Congress on 
Medicare pre-claim review of home health services. The report shall 
include at least the following:
            (1) A comprehensive analysis and description of the impact 
        of Medicare pre-claim review of home health services in any 
        State in which it had been implemented before the date of the 
        enactment of this Act, including its impact on Medicare 
        beneficiaries, home health agencies, physicians, and Medicare 
        administrative costs and the data described in paragraph (5).
            (2) A detailed description of the resources used by home 
        health agencies, physicians, and the Department of Health and 
        Human Services and its contractors in conducting such pre-claim 
        review.
            (3) A description of alternative measures that can be taken 
        to identify the nature of improper payments in Medicare home 
        health services, the root cause for such improper payments, and 
        possible corrective actions (other than the use of pre-claim 
        review) that can be taken.
            (4) Detailed data on the claims subject to, and the result 
        of, Medicare pre-claim review conducted before the date of the 
        enactment of this Act, including the following:
                    (A) The number of pre-claim submissions and 
                resubmissions.
                    (B) The percentage of responses to such submissions 
                and resubmissions that--
                            (i) fully approve (or affirm) such 
                        services;
                            (ii) fully disapprove (or non-affirm) such 
                        services; or
                            (iii) do not fully approve (or affirm), or 
                        fully disapprove (or non-affirm), such 
                        services.
                    (C) Changes in utilization of and spending on 
                Medicare-covered home health services, inpatient 
                hospital care, and skilled nursing facility services.
                    (D) The number of home health agencies in States 
                where such pre-claim review occurred.
                    (E) The average dollar amount per claim and 
                aggregate amount involved in such reviews, based on the 
                types of responses described in subparagraph (B).
                    (F) The 50 diagnosis codes that were most 
                frequently subject to review.
                    (G) The proportion of cases subject to review that 
                were post-acute care.
                    (H) The impact of the review on patient access to 
                home health services.
                    (I) The impact of the review on the continuity of 
                care, including the proportion of cases that result in 
                a disruption or delay in patient care.
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