[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1650 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                S. 1650

To amend title XVIII of the Social Security Act to make changes to the 
       Medicare home health face-to-face encounter requirements.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 23, 2015

  Mr. Menendez (for himself and Mr. Roberts) introduced the following 
  bill; which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to make changes to the 
       Medicare home health face-to-face encounter requirements.

    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 2015''.

SEC. 2. DEVELOPMENT OF A SINGLE FORM OR DOCUMENT TO SATISFY THE HOME 
              HEALTH CERTIFICATION REQUIREMENT.

    (a) Part A.--Section 1814 of the Social Security Act (42 U.S.C. 
1395f) is amended--
            (1) in subsection (a)(2)(C), by striking ``has had a face-
        to-face encounter'' and inserting ``has, subject to subsection 
        (m), had a face-to-face encounter''; and
            (2) by adding at the end the following new subsection:
    ``(m) Implementation of Requirement for Certification for Home 
Health Services.--
            ``(1) In general.--The Secretary shall develop a single 
        form or document to be used by a physician to satisfy the 
        documentation requirements necessary to fulfill the requirement 
        of a face-to-face encounter and other criteria for home health 
        eligibility under subsection (a)(2)(C) (otherwise known as the 
        certification for home health services).
            ``(2) Stakeholder input.--In developing the form or 
        document under paragraph (1), the Secretary shall seek input 
        from stakeholders, including physicians and other non-physician 
        providers (such as nurse practitioners or clinical nurse 
        specialists (as those terms are defined in section 
        1861(aa)(5))), home health agencies, hospitals, patients or 
        representatives of patients, and other entities (such as 
        electronic medical record vendors) the Secretary determines 
        appropriate. The Secretary shall provide the opportunity for 
        such stakeholders to offer input on the form or document during 
        its initial development as well as the opportunity to make 
        comments on a proposed version prior to its finalization. The 
        Secretary shall also set up a process to educate physicians and 
        non-physicians on how to appropriately fulfill the requirements 
        related to the form or document in this section prior to 
        implementation.
            ``(3) Content of form.--The Secretary shall accept the 
        following content as documentation of an individual's 
        eligibility for home health services:
                    ``(A) With respect to the face-to-face encounter 
                requirement, the date of the encounter.
                    ``(B) With respect to homebound status, a statement 
                that provides the clinical basis for why the individual 
                is determined to be confined to the home.
                    ``(C) With respect to the need for skilled 
                services, a selection, via checkbox, of the types of 
                skilled services required by the individual and a 
                statement with the clinical basis for each type of 
                skilled service ordered.
            ``(4) Deemed satisfaction of requirements.--The Secretary 
        shall, through guidance, allow the requirement for 
        documentation of a face-to-face encounter and other criteria 
        for home health eligibility under subsection (a)(2)(C) to be 
        deemed satisfied with respect to an individual if a home health 
        agency completes the form or document under paragraph (1) and 
        the ordering physician signs or attests to the contents of the 
        form or document.
            ``(5) Exception to face-to-face encounter requirement.--The 
        Secretary shall waive the requirement for a face-to-face 
        encounter under subsection (a)(2)(C) related to home health 
        services provided to an individual if the individual has been 
        discharged from a hospital (including from the emergency 
        department) or skilled nursing facility within 14 days prior to 
        the initiation of such home health services.
            ``(6) Guidance to contractors.--
                    ``(A) In general.--The Secretary shall provide 
                notification, guidance, and education regarding the 
                application of the form or document under paragraph (1) 
                as it pertains to satisfying the documentation 
                requirements for home health services under subsection 
                (a)(2)(C) to medicare administrative contractors (as 
                defined in section 1874A), recovery audit contractors 
                (as defined in section 1893(h)), and any other entity 
                which the Secretary determines appropriate.
                    ``(B) National applicability.--The Secretary shall 
                ensure that all medicare administrative contractors, 
                recovery audit contractors, and any other entity which 
                the Secretary determines appropriate apply the guidance 
                under this paragraph in a nationally consistent and 
                uniform manner and that all audit activities, policies, 
                and practices regarding documentation for home health 
                services are likewise applied in a nationally 
                consistent and uniform manner.
                    ``(C) Study.--Not later than 18 months after the 
                date of the enactment of this paragraph, the Secretary 
                shall submit to Congress a report on--
                            ``(i) the adherence of medicare 
                        administrative contractors, recovery audit 
                        contractors, and any other entity which the 
                        Secretary determines appropriate to nationally 
                        consistent and uniform audit activities, 
                        policies, and practices as described in 
                        subparagraph (B); and
                            ``(ii) the rate of appeals for denial of 
                        payment based solely on the face-to-face 
                        encounter requirements for home health services 
                        under this section and the rate of such appeals 
                        that are ultimately successful.''.
    (b) Part B.--Section 1835 of the Social Security Act (42 U.S.C. 
1395n) is amended--
            (1) in subsection (a)(2)(A), by striking ``has had a face-
        to-face encounter'' and inserting ``has, subject to subsection 
        (f), had a face-to-face encounter''; and
            (2) by adding at the end the following new subsection:
    ``(f) Application of Documentation, Guidance, and Treatment of 
Certain Home Health Claims Provisions Under Part A.--The provisions of 
section 1814(m) shall apply with respect to the application of 
documentation requirements for home health services under subsection 
(a)(2)(A) in the same manner as such provisions apply with respect to 
the application of the documentation requirements for home health 
services under section 1814(a)(2)(C).''.

SEC. 3. EFFECTIVE DATE; TREATMENT OF CERTAIN HOME HEALTH CLAIMS.

    (a) Effective Date.--The amendments made by section 2 shall apply 
with respect to home health services furnished on or after October 1, 
2016.
    (b) Treatment of Certain Home Health Claims.--
            (1) Denied claims.--
                    (A) In general.--Not later than 12 months after the 
                date of the enactment of this Act, the Secretary of 
                Health and Human Services shall--
                            (i) through guidance, develop and implement 
                        processes to open and review claims that were 
                        denied on or after January 1, 2011, and before 
                        the date of the enactment of this Act, due 
                        solely to the face-to-face documentation 
                        requirements under section 1814(a)(2)(C) of the 
                        Social Security Act (42 U.S.C. 1395f(a)(2)(C)) 
                        or section 1835(a)(2)(A) of such Act (42 U.S.C. 
                        1395f(a)(2)(A)); and
                            (ii) issue revised decisions of such 
                        denials as if the narrative requirements of 
                        section 424.22(v) of title 42, Code of Federal 
                        Regulations, did not apply at the time such 
                        services were furnished.
                    (B) Settlement agreements for denied claims.--In 
                addition to the processes under subparagraph (A), not 
                later than 60 days after the date of the enactment of 
                this Act, the Secretary shall establish a voluntary 
                process for home health agencies to enter into a 
                settlement agreement with the Secretary of Health and 
                Human Services in lieu of reprocessing claims for 
                payment which are required to be paid by reason of 
                subparagraph (A)(ii).
            (2) Other claims.--In the case of a claim for home health 
        services furnished on or after January 1, 2011, and before 
        October 1, 2016, that is not described in paragraph (1)(A), 
        such claim shall be determined and processed as if the 
        narrative requirements of section 424.22(v) of title 42, Code 
        of Federal Regulations, did not apply at the time such services 
        were furnished.
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