On May 25, Representative Kenny Marchant (R-TX) introduced a bill in the House of Representatives that would make home health medical record material a legitimate addition to physician medical records when certifying that a patient is eligible for the home health benefit.
“For purposes of documentation for physician certification and recertification made under paragraph (2) on or after January 1, 2018, and made with respect to home health services furnished by a home health agency, in addition to using documentation in the medical record of the physician who so certifies or the medical record of the acute or post-acute care facility (in the case that home health services were furnished to an individual who was directly admitted to the home health agency from such a facility), the Secretary shall use documentation in the medical record of the home health agency as supporting material, as appropriate to the case involved.”
To be known under the short title, "Home Health Documentation and Program Improvement Act of 2017," H.B. 2663 will also create an optional claims appeal settlement process. It appears that the net effect of Section 3 of the bill would be to allow HHAs to bypass the full appeals process if they are willing to accept a percentage of the appealed amount. If it becomes law, the Secretary of Health and Human Services will be directed to decide what that percentage should be.
(i) The Secretary shall, for purposes of applying clause (ii) with respect to all settlements under paragraph (1), select a percentage. In selecting such percentage, the Secretary shall consider the percentage used under the Centers for Medicare & Medicaid Services hospital appeals settlement that began on October 31, 2014.
The Secretary shall, with respect to each denied claim for such agency that is under an eligible administrative appeal, calculate an amount (referred to in this subparagraph as an “individual claim amount”) by multiplying the net payable amount for such claim by the percentage selected under clause (i).
The bill goes on to specify that an HHA that accepts a settlement payment will forego the right to continue the original appeal. Nor shall there be any administrative or judicial review of a settlement and the claims covered by the settlement. If the HHA enters into settlement negotiations but does not accept the settlement, it may resume the original appeal. The HHS Secretary is also required to coordinate with law enforcement to make sure no settlements are paid for claims that involve fraud or other criminal activity.
To date, H.B. 2663 has one co-sponsor, Rep. Earl Blumenauer (D-OR). The bill has been referred to the Ways and Means Committee's sub-committee on health.
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