,,ii  #aai? ,,congress  #b;d ,session   
,s4 #ebej  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,augu/ #e1 #bjbf,ms4   
,coll9s introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
decrease fraud relat$ to home heal?     
ag5cies 9 ,m$ic>e1 & = o!r purposes4    
#a4 ,%ort title2 ,table ( cont5ts  7a7  
,%ort title ,?is ,act may be cit$ z !   
,m$ic>e ,home ,heal? ,paym5t ,integrity 
& ,protection ,act ( #bjbf4  7b7 ,table 
( cont5ts  ,sec4 #a4 ,%ort title2 ,table
 ( cont5ts4,,title ,i--,home heal?      
program integrity1 anti-fraud1 &        
enrollm5t reform,sec4 #aja4 ,enhanc$    
enrollm5t scre5+ = home heal?           
ag5cies4,sec4 #ajb4 ,additional ov]sight
 provisions = home heal? ag5cies4,sec4  
#ajc4 ,additional survey & tra9+        
requirem5ts = accr$itation              
organizations4,,title ,,ii--,home heal? 
paym5t reset & data integrity,sec4 #bja4
 ,reset ( /&>d prospective paym5t       

am\nt4,sec4 #bjb4 ,susp5sion ( p]man5t &
 tempor>y adju/m5ts4,sec4 #bjc4 ,con=m+ 
protection = b5*m>ks & value-bas$       
programs4,,title ,,iii--,reports1       
rulemak+1 program integrity fund+1 &    
implementation,sec4 #cja4 ,report to    
,congress on home heal? paym5t          
data4,sec4 #cjb4 ,notice & comm5t       
rulemak+4,sec4 #cjc4 ,program integrity 
fund+4,sec4 #cjd4 ,dep>tm5t ( ,ju/ice & 
,(fice ( ,inspector ,g5]al en=cem5t     
fund+4,sec4 #cje4 ,/ate survey ag5cy    
fund+4,sec4 #cjf4 ,rule ( con/ruction   
reg>d+ exi/+ fraud au?orities4  ,i ,home
 heal? program integrity1 anti-fraud1 & 
enrollm5t re=m  #aja4 ,enhanc$ enrollm5t
 scre5+ = home heal? ag5cies ,section   
#ahff7;j77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;cc7j77#b77 is     
am5d$-- 7#a7 9 subp>agraph 7,b7-- 7,a7 9
 clause 7i71 by /rik+ & at ! end2  7,b7 
9 clause 7ii77,v71 by /rik+ ! p]iod at !
 end & ins]t+ 2 &2 &  7,c7 by add+ at ! 
end ! foll[+ new clause3  7iii7 beg9n+  
#a ye> aft] ! date ( enactm5t ( ?is     

clause1 9 ! case ( a home heal? ag5cy   
apply+ = enrollm5t "u ?is title t is at 
an extreme risk ( fraud 7z det]m9$ "u   
subp>agraph 7,g771 %all1 9 addition to  
any o!r scre5+ requir$ "u ?is           
subp>agraph-- 7,i7 9 ! case :]e f+]pr9t+
 is includ$ 9 su* scre5+ ) respect to   
home heal? ag5cies pursuant to clause   
7ii77,,ii71 require f+]pr9t+ ( !        
adm9i/rator ( su* home heal? ag5cy2 &   
7,,ii7 require obta9+ evid5ce t su* home
 heal? ag5cy has a compreh5sive         
liability insurance policy1 z det]m9$ by
 ! ,secret>y4  2 &  7#b7 by add+ at !   
end ! foll[+ new subp>agraph3  7,g7     
,home heal? ag5cies at extreme risk (   
fraud  7i7 ,9 g5]al ,beg9n+ #a ye> aft] 
! date ( enactm5t ( ?is subp>agraph1 =  
purposes ( subp>agraph 7,b77iii71 !     
,secret>y %all det]m9e :e!r a home heal?
 ag5cy is at an extreme risk ( fraud    
bas$ on-- 7,i7 ! det]m9ation made "u    
clause 7ii72 &  7,,ii7 su* o!r factors z
 ! ,secret>y may specify4  7ii7         
,det]m9ation ( high-risk areas ,=       

purposes ( clause 7i71 ! ,secret>y %all 
det]m9e :e!r a home heal? ag5cy is      
locat$ 9 a ,/ate or c\nty ) respect to  
:i*1 dur+ ! mo/ rec5t ye> = :i* data is 
available1 ! total numb] ( home heal?   
ag5cies locat$ 9 su* ,/ate or c\nty     
significantly exce$$ ! total numb] ( su*
 ag5cies locat$ 9 su* ,/ate or c\nty    
dur+ ! prec$+ ye>4  4  #ajb4 ,additional
 ov]sight provisions = home heal?       
ag5cies  7a7 ,increas$ survey frequ5cy =
 c]ta9 home heal? ag5cies ,section      
#ahia7;c77#b77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;bbb7c77#b77;,b77 is am5d$-- 7#a7 9
 clause 7ii71 by /rik+ ! p]iod at ! end 
& ins]t+ a semicolon2  7#b7 by          
r$esignat+ clauses 7i7 & 7ii7 z         
subclauses 7,i7 & 7,,ii71 respectively1 
& adju/+ ! m>g9s accord+ly2  7#c7 by    
/rik+ subp>agraph 7,a71 a /&>d survey & 
ins]t+ ! foll[+3 subp>agraph 7,a7--  7i7
 a /&>d survey  2 &  7#d7 by add+ at !  
end ! foll[+ new clauses3  7ii7 beg9n+  
#a ye> aft] ! date ( enactm5t ( ?is     

clause1 9 ! case :]e an ag5cy is newly  
enroll$ "u ?is title1 has und]gone a    
*ange ( own]%ip 7z def9$ by !           
,secret>y71 or has reactivat$ bill+     
privileges "u ?is title 9 accordance )  
section #dbd4edj7;b7 ( title #db1 ,code 
( ,f$]al ,regulations 7or a successor   
regulation71 a /&>d survey ( su* ag5cy  
%all be conduct$ n less frequ5tly ?an   
once e #ab mon?s dur+ ! #cf-mon? p]iod  
imm$iately foll[+ su* enrollm5t1 *ange (
 own]%ip1 or reactivation ( bill+       
privileges2 &  7iii7 beg9n+ #a ye> aft] 
! date ( enactm5t ( ?is clause1 a /&>d  
survey ( an ag5cy %all be conduct$--    
7,i7 9 ! case :]e ! ag5cy does n submit 
quality data to ! ,secret>y 9 accordance
 ) subclauses 7,,ii7 & 7,,iv7 ( section 
#ahie7;b77#c77;,b77v7 = ! mo/ rec5t ye> 
= :i* data is available 7z det]m9$ by ! 
,secret>y71 n lat] ?an #ah mon?s aft] ! 
date on :i* ! mo/ rec5t su* survey 0    
conduct$ ) respect to su* ag5cy2 &      
7,,ii7 9 ! case :]e ! ag5cy has a       
b5efici>y admission rate t is ab]rant   

comp>$ to pe]s 7z det]m9$ by !          
,secret>y7 or o!rwise displays          
*>act]i/ics or engages 9 practices t may
 indicate fraudul5t or ab]rant behavior 
7z specifi$ by ! ,secret>y aft]         
consultation ) /akehold]s1 su* z        
b5efici>y advocates & repres5tatives ( !
 home heal? indu/ry1 & ! ,inspector     
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices1 & updat$ z necess>y aft]      
additional consultation ) su* /akehold]s
 n less (t5 ?an once e #c ye>s71 n lat] 
?an #ah mon?s aft] ! date on :i* ! mo/  
rec5t su* survey 0 conduct$ ) respect to
 su* ag5cy1  except t an ag5cy %all n be
 subject to m ?an #a survey "u ?is      
clause )9 any #ah-mon? p]iod4  4  7b7   
,paym5t adju/m5t if quality data n      
submitt$ ,section #ahie7;b77#c77;,b77v7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;fff7b77#c77;,b77v77 is  
am5d$-- 7#a7 9 subclause 7,i71 9 ! fir/ 
s5t5ce1 by ins]t+ ! foll[+ be=e ! p]iod3
 = ye>s be=e #bjbi1 & by #ae p]c5tage   
po9ts = #bjbi & subsequ5t ye>s2  7#b7 9 

subclause 7,,ii71 by add+ at ! end !    
foll[+ new s5t5ce3 ,= #bjbi & ea*       
subsequ5t ye>1 9 specify+ a "t = !      
submission ( su* data pursuant to !     
previ\s s5t5ce1 ! ,secret>y %all e/abli%
 a process "u :i* any home heal? ag5cy t
 has demon/rat$ a good fai? ef=t to     
submit su* data by su* "t may be grant$ 
additional "t 7n to exce$ #cj days7 to  
complete su* submission42 &  7#c7 9     
subclause 7,,iv77cc71 by add+ at ! end !
 foll[+ new s5t5ce3 ,= #bjbi & ea*      
subsequ5t ye>1 9 specify+ a "t = !      
submission ( su* data pursuant to !     
previ\s s5t5ce1 ! ,secret>y %all e/abli%
 a process "u :i* any home heal? ag5cy t
 has demon/rat$ a good fai? ef=t to     
submit su* data by su* "t may be grant$ 
additional "t 7n to exce$ #cj days7 to  
complete su* submission44  #ajc4        
,additional survey & tra9+ requirem5ts =
 accr$itation organizations ,section    
#ahfe ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acie;bb7 is am5d$-- 7#a7 9   
subsection 7a77#b7-- 7,a7 by /rik+ ,9   

mak+ & ins]t+ ! foll[+3 7,a7 ,9 mak+2 & 
7,b7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,b7 7i7 ,beg9n+ #a ye>   
aft] ! date ( enactm5t ( ?is            
subp>agraph1 ! ,secret>y may n approve a
 reque/ = a f9d+ "u p>agraph 7#a7 )     
respect to a national accr$itation body 
unless ! survey proc$ures ( su*         
accr$itation body-- 7,i7 met or exce$$ !
 /&>ds applicable to ! survey proc$ures 
t ,/ate & local ag5cies t h ent]$ into  
an agreem5t ) ! ,secret>y "u section    
#ahfd7;a7 are requir$ to use2 &  7,,ii7 
require surveyors to complete ! relevant
 basic surveyor tra9+ c\rses (f]$ by !  
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices be=e
 s]v+ z a memb] ( a survey team4  7ii7  
,! ,secret>y may only cont9ue to give   
effect to any su* f9d+ made prior to !  
date t is #a ye> aft] ! date ( enactm5t 
( ?is subp>agraph ) respect to a        
national accr$itation body ) respect to 
! accr$itation ( home heal? ag5cies if !
 ,secret>y det]m9es be=e su* date t !   
survey proc$ures ( su* accr$itation body

 meet ! conditions describ$ 9 clause    
7i74  2 &  7#b7 by add+ at ! end !      
foll[+ new subsection3  7f7             
,accr$itation = home heal? ag5cies  7#a7
 ,n lat] ?an #a ye> aft] ! date (       
enactm5t ( ?is subsection1 ! ,secret>y  
%all e/abli% & implem5t a me*anism =    
p]iodically assess+ ! p]=mance ( an     
accr$itation body t has receiv$ approval
 f ! ,secret>y "u subsection            
7a77#c77;,a7 = accr$itation ( home heal?
 ag5cies4  7#b7 ,9 ! case t ! ,secret>y 
f9ds1 pursuant to ! me*anism e/abli%$ "u
 p>agraph 7#a71 t ! p]=mance ( su*      
accr$itation body is defici5t1 !        
,secret>y %all provide = an appropriate 
rem$y1 :i* may include ! imposition ( a 
corrective action plan1 ongo+ monitor+ (
 ! accr$itation body1 & ! t]m9ation (   
su* approval ) respect to ! accr$itation
 body = accr$itation ( home heal?       
ag5cies4  4  ,,ii ,home heal? paym5t    
reset & data integrity  #bja4 ,reset (  
/&>d prospective paym5t am\nt ,reset (  
,/&>d ,prospective ,paym5t              

,am\nt4--,section #ahie7;b77#c77;,a7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;fff7b77#c77;,a77 is am5d$-- 7#a7 9
 clause 7i71 9 ! matt] prec$+ subclause 
7,i71 by /rik+ ,"u su* sy/em & ins]t+   
,subject to clause 7v71 "u su* sy/em2   
7#b7 9 clause 7iii7-- 7,a7 9 ! head+1 by
 /rik+ & subsequ5t ye>s & ins]t+ ?r\gh  
#bjbf2 &  7,b7 9 subclause 7,i71 by     
/rik+ & subsequ5t ye>s & ins]t+ ?r\gh   
#bjbf2 &  7#c7 by add+ at ! end ! foll[+
 new clause3  7v7 ,basis = #bjbg &      
subsequ5t ye>s ,) respect to paym5ts =  
home heal? units ( s]vice furni%$ dur+  
#bjbg or a subsequ5t ye>1 ! /&>d        
prospective paym5t am\nt %all be-- 7,i7 
= #bjbg1 #bchb4hg2 &  7,,ii7 = #bjbh &  
ea* subsequ5t ye>1 ! am\nt det]m9$ "u   
?is clause = ! prec$+ ye>1 updat$ "u    
subp>agraph 7,b74  4  #bjb4 ,susp5sion (
 p]man5t & tempor>y adju/m5ts ,section  
#ahie7;b77#c77;,d7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;fff7b77#c77;,d77 is am5d$-- 7#a7 9
 clause 7i71 by /rik+ ,! ,secret>y &    

ins]t+ ,subject to clause 7iv71 !       
,secret>y2 &  7#b7 by add+ at ! end !   
foll[+ new clause3  7iv7 ,susp5sion (   
p]man5t & tempor>y adju/m5ts = #bjbj &  
subsequ5t ye>s ,not)/&+ any o!r         
provision ( law1 = #bjbg & subsequ5t    
ye>s1 = purposes ( mak+ any adju/m5t "u 
?is subp>agraph1 ! ,secret>y %all n     
impose any adju/m5t "u clause 7ii7 or   
7iii7 to (fset increases or decreases 9 
e/imat$ exp5ditures attributable to !   
diff]5ce 9 assum$ v]sus actual          
behavioral *anges due to ! implem5tation
 ( ! ,pati5t-,driv5 ,gr\p+s ,model z    
describ$ 9 ! f9al rule entitl$ #8,m$ic>e
 & ,m$icaid ,programs2 ,,cy #bjbj ,home 
,heal? ,prospective ,paym5t ,sy/em ,rate
 ,update2 ,home ,heal? ,value-,bas$     
,pur*as+ ,model2 ,home ,heal? ,quality  
,report+ ,requirem5ts2 & ,home ,infusion
 ,!rapy ,requirem5ts' publi%$ 9 ! ,f$]al
 ,regi/] on ,novemb] #i1 #bjai 7#hd ,f$4
 ,reg4 #fjdgh74  4  #bjc4 ,con=m+       
protection = b5*m>ks & value-bas$       
programs ,section #ahie ( ! ,social     

,security ,act 7#db ,u4,s4,c4           
#acie;fff71 is am5d$ by add+ at ! end ! 
foll[+ new subsection3  7f7 ,con=m+     
protection = b5*m>ks & value-,bas$      
programs  7#a7 ,9 g5]al ,= #bjbg & ea*  
subsequ5t ye>1 9 ord] to ensure t       
fraudul5t & suspect$ fraudul5t entities 
d n impact b5*m>ks or ! application (   
any quality1 value-bas$1 or b5*m>k$     
adju/m5ts = legitimate provid]s ( home  
heal? s]vices1 ! ,secret>y %all exclude 
or adju/ = suspect claims :5 comput+ any
 su* adju/m5ts to paym5ts to home heal? 
ag5cies "u ?is section4  7#b7  ,suspect 
claim def9$  ,9 ?is subsection1 ! t]m   
suspect claim means any claim = home    
heal? s]vices submitt$ "u ?is title t ! 
,secret>y det]m9es conta9s unreliable   
data or data f a provid] t may h engag$ 
9 fraud1 wa/e1 or abuse4  4  ,,iii      
,reports1 rulemak+1 program integrity   
fund+1 & implem5tation  #cja4 ,report to
 ,congress on home heal? paym5t data ,n 
lat] ?an #ahj days aft] ! date (        
enactm5t ( ?is ,act1 ! ,secret>y (      

,heal? & ,human ,s]vices %all submit to 
,congress a report-- 7#a7 id5tify+ !    
degree to :i* suspect claims & co/      
reports influ5c$ paym5ts made to home   
heal? ag5cies "u section #ahie ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acie;fff7 aft] #bjbj2  7#b7 analyz+ !  
effect ( exclud+ suspect claims 7z def9$
 9 subsection 7f7 ( su* section #ahie7 f
 ! calculation ( paym5t rates1 case-mix 
weights1 behavioral assumptions1 &      
adju/m5ts "u su* section #ahie2 &  7#c7 
includ+ recomm5dations = p]man5t        
data-integrity safegu>ds = home heal?   
ag5cies to prev5t ! inclusion &         
application ( utilization1 co/1 & paym5t
 data f home heal? ag5cies t ! ,secret>y
 det]m9es are at risk ( provid+         
unreliable & inaccurate data4  #cjb4    
,notice & comm5t rulemak+ ,! ,secret>y (
 ,heal? & ,human ,s]vices %all implem5t 
! am5dm5ts made by titles ,i & ,,ii (   
?is ,act ?r\gh notice & comm5t rulemak+ 
"u section #eec ( title #e1 ,unit$      
,/ates ,code4  #cjc4 ,program integrity 

fund+ ,9 addition to any o!r funds      
o!rwise available1 !re are appropriat$  
to ! ,c5t]s = ,m$ic>e  ,m$icaid         
,s]vices1 out ( any am\nts 9 ! ,treasury
 n o!rwise appropriat$1 #cjj1jjj1jjj =  
fiscal ye>s #bjbg ?r\gh #bjca = !       
implem5tation ( ! am5dm5ts made by      
sections #aja1 #ajb1 & #ajc4  #cjd4     
,dep>tm5t ( ,ju/ice & ,(fice (          
,inspector ,g5]al en=cem5t fund+ ,9     
addition to any o!r funds o!rwise       
available1 !re are appropriat$ to !     
,dep>tm5t ( ,ju/ice & ! ,(fice (        
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices1 out ( any am\nts 9 !
 ,treasury n o!rwise appropriat$1       
#aej1jjj1jjj = fiscal ye>s #bjbg ?r\gh  
#bjca = inve/igation ( organiz$ home    
heal? fraud s*emes1 =5sic acc\nt+1      
int]/ate fraud inve/igations1           
prosecution ( ,m$ic>e fraud1 &          
coord9ation ) ,f$]al law en=cem5t       
ag5cies4  #cje4 ,/ate survey ag5cy fund+
 ,9 addition to any o!r funds o!rwise   
available1 !re are appropriat$ to !     

,c5t]s = ,m$ic>e  ,m$icaid ,s]vices1 out
 ( any am\nts 9 ! ,treasury n o!rwise   
appropriat$1 #ajj1jjj1jjj = fiscal ye>s 
#bjbg ?r\gh #bjca to support ,/ate      
survey ag5cy activities relat+ to       
conduct+ accel]at$ surveys1 enrollm5t   
validation1 unann\nc$ site visits1 &    
op]ational v]ification ( home heal?     
ag5cies4  #cjf4 ,rule ( con/ruction     
reg>d+ exi/+ fraud au?orities ,no?+ 9 ! 
provisions (1 or am5dm5ts made by1 ?is  
,act %all be con/ru$ to limit ! au?ority
 ( ! ,secret>y ( ,heal? & ,human        
,s]vices to susp5d paym5ts to home heal?
 ag5cies "u title ,,xviii ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acie et  
seq471 revoke enrollm5t or impose a     
moratorium on ! enrollm5t ( su* ag5cies 
"u su* title1 conduct site visits ( su* 
ag5cies1 audit su* ag5cies1 or exclude  
or d5y paym5t = suspect claims = home   
heal? s]vices "u su* title4