,,ii  #aaith ,,congress  #b;d ,session  
,s4 #ebej  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,august #e1    
#bjbf,ms4 ,collins 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 decrease  
fraud related to home health agencies in
 ,medicare1 and for other purposes4  #a4
 ,short title2 ,table of contents  7a7  
,short title ,this ,act may be cited as 
the ,medicare ,home ,health ,payment    
,integrity and ,protection ,act of      
#bjbf4  7b7 ,table of contents  ,sec4   
#a4 ,short title2 ,table of             
contents4,,title ,i--,home health       
program integrity1 anti-fraud1 and      
enrollment reform,sec4 #aja4 ,enhanced  
enrollment screening for home health    
agencies4,sec4 #ajb4 ,additional        
oversight provisions for home health    
agencies4,sec4 #ajc4 ,additional survey 
and training requirements for           
accreditation organizations4,,title     

,,ii--,home health payment reset and    
data integrity,sec4 #bja4 ,reset of     
standard prospective payment            
amount4,sec4 #bjb4 ,suspension of       
permanent and temporary                 
adjustments4,sec4 #bjc4 ,conforming     
protection for benchmarks and           
value-based programs4,,title            
,,iii--,reports1 rulemaking1 program    
integrity funding1 and                  
implementation,sec4 #cja4 ,report to    
,congress on home health payment        
data4,sec4 #cjb4 ,notice and comment    
rulemaking4,sec4 #cjc4 ,program         
integrity funding4,sec4 #cjd4           
,department of ,justice and ,office of  
,inspector ,general enforcement         
funding4,sec4 #cje4 ,state survey agency
 funding4,sec4 #cjf4 ,rule of           
construction regarding existing fraud   
authorities4  ,i ,home health program   
integrity1 anti-fraud1 and enrollment   
reform  #aja4 ,enhanced enrollment      
screening for home health agencies      
,section #ahff7;j77#b7 of the ,social   

,security ,act 7#db ,u4,s4,c4           
#acie;cc7j77#b77 is amended-- 7#a7 in   
subparagraph 7,b7-- 7,a7 in clause 7i71 
by striking and at the end2  7,b7 in    
clause 7ii77,v71 by striking the period 
at the end and inserting 2 and2 and     
7,c7 by adding at the end the following 
new clause3  7iii7 beginning #a year    
after the date of enactment of this     
clause1 in the case of a home health    
agency applying for enrollment under    
this title that is at an extreme risk of
 fraud 7as determined under subparagraph
 7,g771 shall1 in addition to any other 
screening required under this           
subparagraph-- 7,i7 in the case where   
fingerprinting is included in such      
screening with respect to home health   
agencies pursuant to clause 7ii77,,ii71 
require fingerprinting of the           
administrator of such home health       
agency2 and  7,,ii7 require obtaining   
evidence that such home health agency   
has a comprehensive liability insurance 
policy1 as determined by the ,secretary4

  2 and  7#b7 by adding at the end the  
following new subparagraph3  7,g7 ,home 
health agencies at extreme risk of fraud
  7i7 ,in general ,beginning #a year    
after the date of enactment of this     
subparagraph1 for purposes of           
subparagraph 7,b77iii71 the ,secretary  
shall determine whether a home health   
agency is at an extreme risk of fraud   
based on-- 7,i7 the determination made  
under clause 7ii72 and  7,,ii7 such     
other factors as the ,secretary may     
specify4  7ii7 ,determination of        
high-risk areas ,for purposes of clause 
7i71 the ,secretary shall determine     
whether a home health agency is located 
in a ,state or county with respect to   
which1 during the most recent year for  
which data is available1 the total      
number of home health agencies located  
in such ,state or county significantly  
exceeded the total number of such       
agencies located in such ,state or      
county during the preceding year4  4    
#ajb4 ,additional oversight provisions  

for home health agencies  7a7 ,increased
 survey frequency for certain home      
health agencies ,section                
#ahia7;c77#b77;,b7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;bbb7c77#b77;,b77 is amended-- 7#a7
 in clause 7ii71 by striking the period 
at the end and inserting a semicolon2   
7#b7 by redesignating clauses 7i7 and   
7ii7 as subclauses 7,i7 and 7,,ii71     
respectively1 and adjusting the margins 
accordingly2  7#c7 by striking          
subparagraph 7,a71 a standard survey and
 inserting the following3 subparagraph  
7,a7--  7i7 a standard survey  2 and    
7#d7 by adding at the end the following 
new clauses3  7ii7 beginning #a year    
after the date of enactment of this     
clause1 in the case where an agency is  
newly enrolled under this title1 has    
undergone a change of ownership 7as     
defined by the ,secretary71 or has      
reactivated billing privileges under    
this title in accordance with section   
#dbd4edj7;b7 of title #db1 ,code of     

,federal ,regulations 7or a successor   
regulation71 a standard survey of such  
agency shall be conducted not less      
frequently than once every #ab months   
during the #cf-month period immediately 
following such enrollment1 change of    
ownership1 or reactivation of billing   
privileges2 and  7iii7 beginning #a year
 after the date of enactment of this    
clause1 a standard survey of an agency  
shall be conducted-- 7,i7 in the case   
where the agency does not submit quality
 data to the ,secretary in accordance   
with subclauses 7,,ii7 and 7,,iv7 of    
section #ahie7;b77#c77;,b77v7 for the   
most recent year for which data is      
available 7as determined by the         
,secretary71 not later than #ah months  
after the date on which the most recent 
such survey was conducted with respect  
to such agency2 and  7,,ii7 in the case 
where the agency has a beneficiary      
admission rate that is aberrant compared
 to peers 7as determined by the         
,secretary7 or otherwise displays       

characteristics or engages in practices 
that may indicate fraudulent or aberrant
 behavior 7as specified by the          
,secretary after consultation with      
stakeholders1 such as beneficiary       
advocates and representatives of the    
home health industry1 and the ,inspector
 ,general of the ,department of ,health 
and ,human ,services1 and updated as    
necessary after additional consultation 
with such stakeholders not less often   
than once every #c years71 not later    
than #ah months after the date on which 
the most recent such survey was         
conducted with respect to such agency1  
except that an agency shall not be      
subject to more than #a survey under    
this clause within any #ah-month period4
  4  7b7 ,payment adjustment if quality 
data not submitted ,section             
#ahie7;b77#c77;,b77v7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#acie;fff7b77#c77;,b77v77 is amended--  
7#a7 in subclause 7,i71 in the first    
sentence1 by inserting the following    

before the period3 for years before     
#bjbi1 and by #ae percentage points for 
#bjbi and subsequent years2  7#b7 in    
subclause 7,,ii71 by adding at the end  
the following new sentence3 ,for #bjbi  
and each subsequent year1 in specifying 
a time for the submission of such data  
pursuant to the previous sentence1 the  
,secretary shall establish a process    
under which any home health agency that 
has demonstrated a good faith effort to 
submit such data by such time may be    
granted additional time 7not to exceed  
#cj days7 to complete such submission42 
and  7#c7 in subclause 7,,iv77cc71 by   
adding at the end the following new     
sentence3 ,for #bjbi and each subsequent
 year1 in specifying a time for the     
submission of such data pursuant to the 
previous sentence1 the ,secretary shall 
establish a process under which any home
 health agency that has demonstrated a  
good faith effort to submit such data by
 such time may be granted additional    
time 7not to exceed #cj days7 to        

complete such submission44  #ajc4       
,additional survey and training         
requirements for accreditation          
organizations ,section #ahfe of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;bb7 is amended-- 7#a7 in          
subsection 7a77#b7-- 7,a7 by striking   
,in making and inserting the following3 
7,a7 ,in making2 and  7,b7 by adding at 
the end the following new subparagraph3 
7,b7 7i7 ,beginning #a year after the   
date of enactment of this subparagraph1 
the ,secretary may not approve a request
 for a finding under paragraph 7#a7 with
 respect to a national accreditation    
body unless the survey procedures of    
such accreditation body-- 7,i7 met or   
exceeded the standards applicable to the
 survey procedures that ,state and local
 agencies that have entered into an     
agreement with the ,secretary under     
section #ahfd7;a7 are required to use2  
and  7,,ii7 require surveyors to        
complete the relevant basic surveyor    
training courses offered by the ,centers

 for ,medicare  ,medicaid ,services     
before serving as a member of a survey  
team4  7ii7 ,the ,secretary may only    
continue to give effect to any such     
finding made prior to the date that is  
#a year after the date of enactment of  
this subparagraph with respect to a     
national accreditation body with respect
 to the accreditation of home health    
agencies if the ,secretary determines   
before such date that the survey        
procedures of such accreditation body   
meet the conditions described in clause 
7i74  2 and  7#b7 by adding at the end  
the following new subsection3  7f7      
,accreditation for home health agencies 
7#a7 ,not later than #a year after the  
date of enactment of this subsection1   
the ,secretary shall establish and      
implement a mechanism for periodically  
assessing the performance of an         
accreditation body that has received    
approval from the ,secretary under      
subsection 7a77#c77;,a7 for             
accreditation of home health agencies4  

7#b7 ,in the case that the ,secretary   
finds1 pursuant to the mechanism        
established under paragraph 7#a71 that  
the performance of such accreditation   
body is deficient1 the ,secretary shall 
provide for an appropriate remedy1 which
 may include the imposition of a        
corrective action plan1 ongoing         
monitoring of the accreditation body1   
and the termination of such approval    
with respect to the accreditation body  
for accreditation of home health        
agencies4  4  ,,ii ,home health payment 
reset and data integrity  #bja4 ,reset  
of standard prospective payment amount  
,reset of ,standard ,prospective        
,payment ,amount4--,section             
#ahie7;b77#c77;,a7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;fff7b77#c77;,a77 is amended-- 7#a7
 in clause 7i71 in the matter preceding 
subclause 7,i71 by striking ,under such 
system and inserting ,subject to clause 
7v71 under such system2  7#b7 in clause 
7iii7-- 7,a7 in the heading1 by striking

 and subsequent years and inserting     
through #bjbf2 and  7,b7 in subclause   
7,i71 by striking and subsequent years  
and inserting through #bjbf2 and  7#c7  
by adding at the end the following new  
clause3  7v7 ,basis for #bjbg and       
subsequent years ,with respect to       
payments for home health units of       
service furnished during #bjbg or a     
subsequent year1 the standard           
prospective payment amount shall be--   
7,i7 for #bjbg1 #bchb4hg2 and  7,,ii7   
for #bjbh and each subsequent year1 the 
amount determined under this clause for 
the preceding year1 updated under       
subparagraph 7,b74  4  #bjb4 ,suspension
 of permanent and temporary adjustments 
,section #ahie7;b77#c77;,d7 of the      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;fff7b77#c77;,d77 is amended-- 7#a7
 in clause 7i71 by striking ,the        
,secretary and inserting ,subject to    
clause 7iv71 the ,secretary2 and  7#b7  
by adding at the end the following new  
clause3  7iv7 ,suspension of permanent  

and temporary adjustments for #bjbj and 
subsequent years ,notwithstanding any   
other provision of law1 for #bjbg and   
subsequent years1 for purposes of making
 any adjustment under this subparagraph1
 the ,secretary shall not impose any    
adjustment under clause 7ii7 or 7iii7 to
 offset increases or decreases in       
estimated expenditures attributable to  
the difference in assumed versus actual 
behavioral changes due to the           
implementation of the ,patient-,driven  
,groupings ,model as described in the   
final rule entitled #8,medicare and     
,medicaid ,programs2 ,,cy #bjbj ,home   
,health ,prospective ,payment ,system   
,rate ,update2 ,home ,health            
,value-,based ,purchasing ,model2 ,home 
,health ,quality ,reporting             
,requirements2 and ,home ,infusion      
,therapy ,requirements' published in the
 ,federal ,register on ,november #i1    
#bjai 7#hd ,fed4 ,reg4 #fjdgh74  4      
#bjc4 ,conforming protection for        
benchmarks and value-based programs     

,section #ahie of the ,social ,security 
,act 7#db ,u4,s4,c4 #acie;fff71 is      
amended by adding at the end the        
following new subsection3  7f7          
,conforming protection for benchmarks   
and value-,based programs  7#a7 ,in     
general ,for #bjbg and each subsequent  
year1 in order to ensure that fraudulent
 and suspected fraudulent entities do   
not impact benchmarks or the application
 of any quality1 value-based1 or        
benchmarked adjustments for legitimate  
providers of home health services1 the  
,secretary shall exclude or adjust for  
suspect claims when computing any such  
adjustments to payments to home health  
agencies under this section4  7#b7      
,suspect claim defined  ,in this        
subsection1 the term suspect claim means
 any claim for home health services     
submitted under this title that the     
,secretary determines contains          
unreliable data or data from a provider 
that may have engaged in fraud1 waste1  
or abuse4  4  ,,iii ,reports1           

rulemaking1 program integrity funding1  
and implementation  #cja4 ,report to    
,congress on home health payment data   
,not later than #ahj days after the date
 of enactment of this ,act1 the         
,secretary of ,health and ,human        
,services shall submit to ,congress a   
report-- 7#a7 identifying the degree to 
which suspect claims and cost reports   
influenced payments made to home health 
agencies under section #ahie of the     
,social ,security ,act 7#db ,u4,s4,c4   
#acie;fff7 after #bjbj2  7#b7 analyzing 
the effect of excluding suspect claims  
7as defined in subsection 7f7 of such   
section #ahie7 from the calculation of  
payment rates1 case-mix weights1        
behavioral assumptions1 and adjustments 
under such section #ahie2 and  7#c7     
including recommendations for permanent 
data-integrity safeguards for home      
health agencies to prevent the inclusion
 and application of utilization1 cost1  
and payment data from home health       
agencies that the ,secretary determines 

are at risk of providing unreliable and 
inaccurate data4  #cjb4 ,notice and     
comment rulemaking ,the ,secretary of   
,health and ,human ,services shall      
implement the amendments made by titles 
,i and ,,ii of this ,act through notice 
and comment rulemaking under section    
#eec of title #e1 ,united ,states ,code4
  #cjc4 ,program integrity funding ,in  
addition to any other funds otherwise   
available1 there are appropriated to the
 ,centers for ,medicare  ,medicaid      
,services1 out of any amounts in the    
,treasury not otherwise appropriated1   
#cjj1jjj1jjj for fiscal years #bjbg     
through #bjca for the implementation of 
the amendments made by sections #aja1   
#ajb1 and #ajc4  #cjd4 ,department of   
,justice and ,office of ,inspector      
,general enforcement funding ,in        
addition to any other funds otherwise   
available1 there are appropriated to the
 ,department of ,justice and the ,office
 of ,inspector ,general of the          
,department of ,health and ,human       

,services1 out of any amounts in the    
,treasury not otherwise appropriated1   
#aej1jjj1jjj for fiscal years #bjbg     
through #bjca for investigation of      
organized home health fraud schemes1    
forensic accounting1 interstate fraud   
investigations1 prosecution of ,medicare
 fraud1 and coordination with ,federal  
law enforcement agencies4  #cje4 ,state 
survey agency funding ,in addition to   
any other funds otherwise available1    
there are appropriated to the ,centers  
for ,medicare  ,medicaid ,services1 out 
of any amounts in the ,treasury not     
otherwise appropriated1 #ajj1jjj1jjj for
 fiscal years #bjbg through #bjca to    
support ,state survey agency activities 
relating to conducting accelerated      
surveys1 enrollment validation1         
unannounced site visits1 and operational
 verification of home health agencies4  
#cjf4 ,rule of construction regarding   
existing fraud authorities ,nothing in  
the provisions of1 or amendments made   
by1 this ,act shall be construed to     

limit the authority of the ,secretary of
 ,health and ,human ,services to suspend
 payments to home health agencies under 
title ,,xviii of the ,social ,security  
,act 7#db ,u4,s4,c4 #acie et seq471     
revoke enrollment or impose a moratorium
 on the enrollment of such agencies     
under such title1 conduct site visits of
 such agencies1 audit such agencies1 or 
exclude or deny payment for suspect     
claims for home health services under   
such title4