,,ii  #aadth ,,congress  #ast ,session  
,s4 #afej  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,june #bc1     
#bjae ,mr4 ,menendez 7for himself and   
,mr4 ,roberts7 introduced the following 
bill2 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 requirements4  #a4 ,short     
title  ,this ,act may be cited as the   
,home ,health ,documentation and        
,program ,improvement ,act of #bjae4    
#b4 ,development of a single form or    
document to satisfy the home health     
certification requirement  7a7 ,part ,a 
,section #ahad of the ,social ,security 
,act 7#db ,u4,s4,c4 #acie;f7 is         
amended-- 7#a7 in subsection            
7a77#b77;,c71 by striking has had a     
face-to-face encounter and inserting    
has1 subject to subsection 7m71 had a   
face-to-face encounter2 and  7#b7 by    
adding at the end the following new     

subsection3  7m7 ,implementation of     
requirement for certification for home  
health services  7#a7 ,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 7a77#b77;,c7 7otherwise
 known as the certification for home    
health services74  7#b7 ,stakeholder    
input ,in developing the form or        
document under paragraph 7#a71 the      
,secretary shall seek input from        
stakeholders1 including physicians and  
other non-physician providers 7such as  
nurse practitioners or clinical nurse   
specialists 7as those terms are defined 
in section #ahfa7;aa77#e7771 home health
 agencies1 hospitals1 patients or       
representatives of patients1 and other  
entities 7such as electronic medical    
record vendors7 the ,secretary          
determines appropriate4 ,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 finalization4 ,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       
implementation4  7#c7 ,content of form  
,the ,secretary shall accept the        
following content as documentation of an
 individual's eligibility for home      
health services3  7,a7 ,with respect to 
the face-to-face encounter requirement1 
the date of the encounter4  7,b7 ,with  
respect to homebound status1 a statement
 that provides the clinical basis for   
why the individual is determined to be  
confined to the home4  7,c7 ,with       
respect to the need for skilled         
services1 a selection1 via checkbox1 of 
the types of skilled services required  

by the individual and a statement with  
the clinical basis for each type of     
skilled service ordered4  7#d7 ,deemed  
satisfaction of requirements ,the       
,secretary shall1 through guidance1     
allow the requirement for documentation 
of a face-to-face encounter and other   
criteria for home health eligibility    
under subsection 7a77#b77;,c7 to be     
deemed satisfied with respect to an     
individual if a home health agency      
completes the form or document under    
paragraph 7#a7 and the ordering         
physician signs or attests to the       
contents of the form or document4  7#e7 
,exception to face-to-face encounter    
requirement ,the ,secretary shall waive 
the requirement for a face-to-face      
encounter under subsection 7a77#b77;,c7 
related to home health services provided
 to an individual if the individual has 
been discharged from a hospital         
7including from the emergency           
department7 or skilled nursing facility 
within #ad days prior to the initiation 

of such home health services4  7#f7     
,guidance to contractors  7,a7 ,in      
general ,the ,secretary shall provide   
notification1 guidance1 and education   
regarding the application of the form or
 document under paragraph 7#a7 as it    
pertains to satisfying the documentation
 requirements for home health services  
under subsection 7a77#b77;,c7 to        
medicare administrative contractors 7as 
defined in section #ahgd;,a71 recovery  
audit contractors 7as defined in section
 #ahic7;h771 and any other entity which 
the ,secretary determines appropriate4  
7,b7 ,national applicability ,the       
,secretary shall ensure that all        
medicare administrative contractors1    
recovery audit contractors1 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 activities1         
policies1 and practices regarding       
documentation for home health services  

are likewise applied in a nationally    
consistent and uniform manner4  7,c7    
,study ,not later than #ah months after 
the date of the enactment of this       
paragraph1 the ,secretary shall submit  
to ,congress a report on--  7i7 the     
adherence of medicare administrative    
contractors1 recovery audit contractors1
 and any other entity which the         
,secretary determines appropriate to    
nationally consistent and uniform audit 
activities1 policies1 and practices as  
described in subparagraph 7,b72 and     
7ii7 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    
successful4  4  7b7 ,part ,b ,section   
#ahce of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acien7 is amended-- 7#a7 in 
subsection 7a77#b77;,a71 by striking has
 had a face-to-face encounter and       
inserting has1 subject to subsection    
7f71 had a face-to-face encounter2 and  

7#b7 by adding at the end the following 
new subsection3  7f7 ,application of    
documentation1 guidance1 and treatment  
of certain home health claims provisions
 under part ,a ,the provisions of       
section #ahad7m7 shall apply with       
respect to the application of           
documentation requirements for home     
health services under subsection        
7a77#b77;,a7 in the same manner as such 
provisions apply with respect to the    
application of the documentation        
requirements for home health services   
under section #ahad7;a77#b77;,c74  4    
#c4 ,effective date2 treatment of       
certain home health claims  7a7         
,effective date ,the amendments made by 
section #b shall apply with respect to  
home health services furnished on or    
after ,october #a1 #bjaf4  7b7          
,treatment of certain home health claims
  7#a7 ,denied claims  7,a7 ,in general 
,not later than #ab months after the    
date of the enactment of this ,act1 the 
,secretary of ,health and ,human        

,services shall--  7i7 through guidance1
 develop and implement processes to open
 and review claims that were denied on  
or after ,january #a1 #bjaa1 and before 
the date of the enactment of this ,act1 
due solely to the face-to-face          
documentation requirements under section
 #ahad7;a77#b77;,c7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;f7a77#b77;,c77 or section         
#ahce7;a77#b77;,a7 of such ,act 7#db    
,u4,s4,c4 #acie;f7a77#b77;,a772 and     
7ii7 issue revised decisions of such    
denials as if the narrative requirements
 of section #dbd4bb7v7 of title #db1    
,code of ,federal ,regulations1 did not 
apply at the time such services were    
furnished4  7,b7 ,settlement agreements 
for denied claims ,in addition to the   
processes under subparagraph 7,a71 not  
later than #fj days after the date of   
the enactment of this ,act1 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 7,a77ii74
  7#b7 ,other claims ,in the case of a  
claim for home health services furnished
 on or after ,january #a1 #bjaa1 and    
before ,october #a1 #bjaf1 that is not  
described in paragraph 7#a77;,a71 such  
claim shall be determined and processed 
as if the narrative requirements of     
section #dbd4bb7v7 of title #db1 ,code  
of ,federal ,regulations1 did not apply 
at the time such services were          
furnished4