Summary of H.R. 2663: Home Health Documentation and Program Improvement Act of 2017
Note: This summary reviews H.R. 2663 based off of the March 20, 2017 version of the bill, prior to its official introduction in the House. The March 20, 2017 is believed to be the same version as wasactually introduced.
Overview
On May 25, 2017, Representatives Rep. Kenny Marchant (R-TX) and Rep. Earl Blumenauer (D-OR) introduced H.R. 2663, the Home Health Documentation and Program Improvement Act of 2017, which would reform the face-to-face/physician recertification documentation requirements for the Medicare home health benefit. The Ways and Means Committee and Energy and Commerce Committees have jurisdiction over the bill. The bill’s last action was its referral to Energy and Commerce on May 25, 2017.
The bill is nearly identical to draft legislation previously proposed by Representative Greg Walden (R-OR) in 2015.
H.R. 2663 would ease the physician documentation requirement by merely requiring demonstration that a timely encounter occurred and narrow the circumstances where a face-to-face encounter is required by excluding patients transferred from a hospital or SNF. The bill also addresses CMS’s past claim denials by requiring CMS to either reach a settlement with affected home health agencies or reopen and pay those claims denied related to the physician narrative.
Provisions of the Bill
- Information to Satisfy Documentation of Medicare Eligibility for Home Health Services
The bill proposes to allow the Secretary to considerdocumentation from a home health agency (HHA) related to a patient’s certification or recertification for eligibility for home health on or after January 1, 2018. For patients admitted to a HHA directly from an acute or post-acute care facility, in addition to using the documentation in the medical record of the physician certifying a patient’s eligibility or the medical record of an acute or post-acute care facility, the Secretary would also be required to consider “documentation in the medical record of the home health agency as supporting material”.
- Voluntary Settlement of Home Health Claims
The Secretary would be required to establish a settlement process for pending HHA claims whereby the Secretary would determine an aggregate amount to be paid to the HHA for all eligible claims under administrative review. The bill does not entitle an HHA to resolve their pending claims with a settlement process, it merely requires HHS to establish such a process. The Secretary would have one year from the date of the enactment of the bill to establish the settlement process.
In determining the amount to be paid to the HHA, the bill directs the Secretary to select a percentage by “considering” the percentage used under the CMS hospital appeals settlements process from Oct. 31 2014. The Secretary is to use the percentage chosen and multiply it by the net payable amount from each denied claim under administrative appeal to calculate the amount to be payable to the HHA.
By electing to accept the settlement, an HHA would be foreclosed from pursuing further administrative appeals or judicial review of the claim (including any redetermination, reconsideration, hearing, or review).