,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #bffc  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,may #be1 #bjag,mr4   
,m>*ant 7= himself & ,mr4 ,blum5au]7    
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means1 & 9    
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to make *anges to
 docum5tation ( eligibility = ,m$ic>e   
home heal? s]vices1 & = o!r purposes4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,home ,heal? ,docum5tation & ,program 
,improvem5t ,act ( #bjag4  #b4          
,in=mation to satisfy docum5tation (    
,m$ic>e eligibility = home heal? s]vices
  7a7 ,"p ,a ,section #ahad7;a7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;f7a77 is am5d$ by ins]t+ be=e ,=  
purposes ( p>agraph 7#b77;,c71 ! foll[+ 
new s5t5ce3 ,= purposes ( docum5tation =

 physician c]tification & rec]tification
 made "u p>agraph 7#b7 on or aft]       
,janu>y #a1 #bjah1 & made ) respect to  
home heal? s]vices furni%$ by a home    
heal? ag5cy1 9 addition to us+          
docum5tation 9 ! m$ical record ( !      
physician :o s c]tifies or ! m$ical     
record ( ! acute or po/-acute c>e       
facility 79 ! case t home heal? s]vices 
7 furni%$ to an individual :o 0 directly
 admitt$ to ! home heal? ag5cy f su* a  
facility71 ! ,secret>y %all use         
docum5tation 9 ! m$ical record ( ! home 
heal? ag5cy z support+ mat]ial1 z       
appropriate to ! case involv$44  7b7 ,"p
 ,b ,section #ahce7;a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acien7a77
 is am5d$ by ins]t+ be=e ,= purposes (  
p>agraph 7#b77;,a71 ! foll[+ new s5t5ce3
 ,= purposes ( docum5tation = physician 
c]tification & rec]tification made "u   
p>agraph 7#b7 on or aft] ,janu>y #a1    
#bjah1 & made ) respect to home heal?   
s]vices furni%$ by a home heal? ag5cy1 9
 addition to us+ docum5tation 9 ! m$ical

 record ( ! physician :o s c]tifies or !
 m$ical record ( ! acute or po/-acute   
c>e facility 79 ! case t home heal?     
s]vices 7 furni%$ to an individual :o 0 
directly admitt$ to ! home heal? ag5cy f
 su* a facility71 ! ,secret>y %all use  
docum5tation 9 ! m$ical record ( ! home 
heal? ag5cy z support+ mat]ial1 z       
appropriate to ! case involv$44  #c4    
,volunt>y settlem5t ( home heal? claims 
7a7 ,settlem5t process = home heal?     
claims  7#a7 ,9 g5]al ,n lat] ?an "o ye>
 aft] ! date ( enactm5t ( ?is ,act1 !   
,secret>y ( ,heal? & ,human ,s]vices    
%all e/abli% a settlem5t process "u :i* 
a home heal? ag5cy entitl$ to an        
eligible adm9i/rative appeal has !      
option to ent] into a settlem5t ) !     
,secret>y t is rea*$ 9 a mann] consi/5t 
) ! succe$+ p>agraphs ( ?is subsection4 
7#b7 ,process & consid]ation ( home     
heal? claims ,a settlem5t "u p>agraph   
7#a7 ) a home heal? ag5cy t is ) respect
 to an eligible adm9i/rative appeal may 
only be rea*$ 9 accordance ) ! foll[+   

process3  7,a7 ,a settlem5t "u su*      
p>agraph ) ! home heal? ag5cy %all be ) 
respect to all claims by su* ag5cy1     
subject to p>agraph 7#d71 t1 z ( ! date 
( su* settlem5t1 are "u an eligible     
adm9i/rative appeal4  7,b7 ,= ! duration
 ( ! settlem5t process ) su* ag5cy1 an  
eligible adm9i/rative appeal t is )     
respect to any su* claim by su* ag5cy   
%all be susp5d$4  7,c7 ,"u ! settlem5t  
process1 ! ,secret>y %all det]m9e an    
aggregate am\nt to be paid to ! home    
heal? ag5cy ) respect to all claims by  
su* ag5cy t are "u an eligible          
adm9i/rative appeal 9 ! foll[+ mann]3   
7i7 ,! ,secret>y %all1 = purposes (     
apply+ clause 7ii7 ) respect to all     
settlem5ts "u p>agraph 7#a71 select a   
p]c5tage4 ,9 select+ su* p]c5tage1 !    
,secret>y %all consid] ! p]c5tage us$ "u
 ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices  
hospital appeals settlem5t t began on   
,octob] #ca1 #bjad4  7ii7 ,! ,secret>y  
%all1 ) respect to ea* d5i$ claim = su* 
ag5cy t is "u an eligible adm9i/rative  

appeal1 calculate an am\nt 7ref]r$ to 9 
?is subp>agraph z an individual claim   
am\nt7 by multiply+ ! net payable am\nt 
= su* claim by ! p]c5tage select$ "u    
clause 7i74  7iii7 ,su* aggregate am\nt 
) respect to su* ag5cy %all be det]m9$  
by calculat+ ! total sum ( all !        
individual claim am\nts calculat$ "u    
clause 7ii7 ) respect to su* ag5cy4     
7#c7 ,effect ( process  7,a7 ,effect (  
settlem5t  7i7 ,fur!r appeal ,z "p ( any
 settlem5t "u p>agraph 7#a7 betwe5 a    
home heal? ag5cy & ! ,secret>y1 su* home
 heal? ag5cy %all be requir$ to =ego !  
"r to an adm9i/rative appeal "u section 
#ahfi ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acie;ff7 or section #ahgh (  
su* ,act 7#db ,u4,s4,c4 #acieoo7        
7includ+ any r$et]m9ation1              
reconsid]ation1 he>+1 or review7 )      
respect to any claims = home heal?      
s]vices t are subject to ! settlem5t4   
7ii7 ,judicial review ,!re %all be no   
adm9i/rative or judicial review "u su*  
section #ahfi or o!rwise ( a settlem5t  

"u p>agraph 7#a7 & ! claims cov]$ by !  
settlem5t4  7,b7 ,effect ( no settlem5t 
,9 ! ev5t t ! process describ$ 9        
p>agraph 7#b7 does n1 ) respect to a    
home heal? ag5cy1 result 9 a settlem5t  
"u p>agraph 7#a7 ) su* ag5cy1 any appeal
 "u su* section #ahfi t is ) respect to 
a claim by su* ag5cy t 0 susp5d$        
pursuant to p>agraph 7#b77;,b7 %all     
resume "u su* section4  7#d7            
,coord9ation ) law en=cem5t ,! ,secret>y
 ( ,heal? & ,human ,s]vices %all e/abli%
 a process "u :i* individuals 9 !       
,dep>tm5t ( ,heal? & ,human ,s]vices    
responsible = execut+ a settlem5t "u    
p>agraph 7#a7 may1 9 ord] to avoid !    
inadv]t5t settlem5t ( cases t involve   
fraud or o!r crim9al activity1 coord9ate
 ) appropriate law en=cem5t ag5cies4    
7b7 ,no entitlem5t to settlem5t process 
,no?+ 9 ?is section %all be con/ru$ z   
creat+ an entitlem5t to ent] into a     
settlem5t process e/abli%$ pursuant to  
subsection 7a74  7c7 ,eligible          
adm9i/rative appeal def9$ ,= purposes ( 

?is section1 ! t]m eligible adm9i/rative
 appeal means an appeal "u section #ahfi
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acie;ff7 7includ+ any        
r$et]m9ation1 reconsid]ation1 he>+1 or  
review7--  7#a7 t is ) respect to "o or 
m claims t-- 7,a7 are = home heal?      
s]vices t--  7i7 7 furni%$ on or aft]   
,janu>y #a1 #bjaa1 & be=e ,janu>y #a1   
#bjae2 &  7ii7 7 reasonable & necess>y  
"u section #ahfb7;a77#a77;,a7 ( su* ,act
 7#db ,u4,s4,c4 #aciey7a77#a77;,a772 &  
7,b7 7 timely fil$ consi/5t ) section   
#ahad7;a77#a7 ( su* ,act 7#db ,u4,s4,c4 
#acie;f7a77#a77 or sections             
#ahce7;a77#a7 & #ahdb7;b77#c7 ( su* ,act
 7#db ,u4,s4,c4 #acien7a77#a71          
#acieu7b77#c772 &  7#b7 ei!r-- 7,a7 0   
timely fil$ consi/5t ) section #ahfi (  
su* ,act 7#db ,u4,s4,c4 #acie;ff7 & is  
p5d+2 or  7,b7 = :i* ! applicable "t    
frame to file an appeal has n expir$4   
7d7 ,con=m+ am5dm5t ,section #ahfi ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;ff7 is am5d$ by add+ at ! end !   

foll[+ new subsection3  7j7 ,application
 ) respect to c]ta9 home heal? claims ,=
 ! application ( ! provisions ( ?is     
section ) respect to c]ta9 claims = home
 heal? s]vices t 7 furni%$ on or aft]   
,janu>y #a1 #bjaa1 & be=e ,janu>y #a1   
#bjae1 see section #c ( ! ,home ,heal?  
,docum5tation & ,program ,improvem5t    
,act ( #bjag4  4