text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Home Health Documentation and 
  Program Improvement Act of 2015''.
  
  SEC. 2. DEVELOPMENT OF A SINGLE FORM OR DOCUMENT TO SATISFY THE HOME 
                HEALTH CERTIFICATION REQUIREMENT.
  
      (a) Part A.--Section 1814 of the Social Security Act (42 U.S.C. 
  1395f) is amended--
              (1) in subsection (a)(2)(C), by striking ``has had a face-
          to-face encounter'' and inserting ``has, subject to subsection 
          (m), had a face-to-face encounter''; and
              (2) by adding at the end the following new subsection:
      ``(m) Implementation of Requirement for Certification for Home 
  Health Services.--
              ``(1) 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 (a)(2)(C) (otherwise known as the 
          certification for home health services).
              ``(2) Stakeholder input.--In developing the form or 
          document under paragraph (1), the Secretary shall seek input 
          from stakeholders, including physicians and other non-physician 
          providers (such as nurse practitioners or clinical nurse 
          specialists (as those terms are defined in section 
          1861(aa)(5))), home health agencies, hospitals, patients or 
          representatives of patients, and other entities (such as 
          electronic medical record vendors) the Secretary determines 
          appropriate. 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 finalization. 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 
          implementation.
              ``(3) Content of form.--The Secretary shall accept the 
          following content as documentation of an individual's 
          eligibility for home health services:
                      ``(A) With respect to the face-to-face encounter 
                  requirement, the date of the encounter.
                      ``(B) With respect to homebound status, a statement 
                  that provides the clinical basis for why the individual 
                  is determined to be confined to the home.
                      ``(C) With respect to the need for skilled 
                  services, a selection, via checkbox, of the types of 
                  skilled services required by the individual and a 
                  statement with the clinical basis for each type of 
                  skilled service ordered.
              ``(4) Deemed satisfaction of requirements.--The Secretary 
          shall, through guidance, allow the requirement for 
          documentation of a face-to-face encounter and other criteria 
          for home health eligibility under subsection (a)(2)(C) to be 
          deemed satisfied with respect to an individual if a home health 
          agency completes the form or document under paragraph (1) and 
          the ordering physician signs or attests to the contents of the 
          form or document.
              ``(5) Exception to face-to-face encounter requirement.--The 
          Secretary shall waive the requirement for a face-to-face 
          encounter under subsection (a)(2)(C) related to home health 
          services provided to an individual if the individual has been 
          discharged from a hospital (including from the emergency 
          department) or skilled nursing facility within 14 days prior to 
          the initiation of such home health services.
              ``(6) Guidance to contractors.--
                      ``(A) In general.--The Secretary shall provide 
                  notification, guidance, and education regarding the 
                  application of the form or document under paragraph (1) 
                  as it pertains to satisfying the documentation 
                  requirements for home health services under subsection 
                  (a)(2)(C) to medicare administrative contractors (as 
                  defined in section 1874A), recovery audit contractors 
                  (as defined in section 1893(h)), and any other entity 
                  which the Secretary determines appropriate.
                      ``(B) National applicability.--The Secretary shall 
                  ensure that all medicare administrative contractors, 
                  recovery audit contractors, 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 activities, policies, 
                  and practices regarding documentation for home health 
                  services are likewise applied in a nationally 
                  consistent and uniform manner.
                      ``(C) Study.--Not later than 18 months after the 
                  date of the enactment of this paragraph, the Secretary 
                  shall submit to Congress a report on--
                              ``(i) the adherence of medicare 
                          administrative contractors, recovery audit 
                          contractors, and any other entity which the 
                          Secretary determines appropriate to nationally 
                          consistent and uniform audit activities, 
                          policies, and practices as described in 
                          subparagraph (B); and
                              ``(ii) 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 successful.''.
      (b) Part B.--Section 1835 of the Social Security Act (42 U.S.C. 
  1395n) is amended--
              (1) in subsection (a)(2)(A), by striking ``has had a face-
          to-face encounter'' and inserting ``has, subject to subsection 
          (f), had a face-to-face encounter''; and
              (2) by adding at the end the following new subsection:
      ``(f) Application of Documentation, Guidance, and Treatment of 
  Certain Home Health Claims Provisions Under Part A.--The provisions of 
  section 1814(m) shall apply with respect to the application of 
  documentation requirements for home health services under subsection 
  (a)(2)(A) in the same manner as such provisions apply with respect to 
  the application of the documentation requirements for home health 
  services under section 1814(a)(2)(C).''.
  
  SEC. 3. EFFECTIVE DATE; TREATMENT OF CERTAIN HOME HEALTH CLAIMS.
  
      (a) Effective Date.--The amendments made by section 2 shall apply 
  with respect to home health services furnished on or after October 1, 
  2016.
      (b) Treatment of Certain Home Health Claims.--
              (1) Denied claims.--
                      (A) In general.--Not later than 12 months after the 
                  date of the enactment of this Act, the Secretary of 
                  Health and Human Services shall--
                              (i) through guidance, develop and implement 
                          processes to open and review claims that were 
                          denied on or after January 1, 2011, and before 
                          the date of the enactment of this Act, due 
                          solely to the face-to-face documentation 
                          requirements under section 1814(a)(2)(C) of the 
                          Social Security Act (42 U.S.C. 1395f(a)(2)(C)) 
                          or section 1835(a)(2)(A) of such Act (42 U.S.C. 
                          1395f(a)(2)(A)); and
                              (ii) issue revised decisions of such 
                          denials as if the narrative requirements of 
                          section 424.22(v) of title 42, Code of Federal 
                          Regulations, did not apply at the time such 
                          services were furnished.
                      (B) Settlement agreements for denied claims.--In 
                  addition to the processes under subparagraph (A), not 
                  later than 60 days after the date of the enactment of 
                  this Act, 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 (A)(ii).
              (2) Other claims.--In the case of a claim for home health 
          services furnished on or after January 1, 2011, and before 
          October 1, 2016, that is not described in paragraph (1)(A), 
          such claim shall be determined and processed as if the 
          narrative requirements of section 424.22(v) of title 42, Code 
          of Federal Regulations, did not apply at the time such services 
          were furnished.
target: Home Health Documentation and Program Improvement Act of 2015 This bill amends title XVIII (Medicare) of the Social Security Act to direct the Department of Health and Human Services (HHS) to:  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 (otherwise known as the certification for home health services); and notify and provide guidance and education to Medicare administrative contractors, recovery audit contractors, and any other appropriate entity regarding application of the form or document to such documentation requirements.  HHS shall also:  develop and implement processes to open and review claims denied on or after January 1, 2011, and before enactment of this Act, due solely to the face-to-face documentation requirements; issue revised decisions of such denials as if the requirements of related regulations did not apply at the time such services were furnished; and  establish a voluntary process for home health agencies to enter into a settlement agreement with HHS in lieu of reprocessing claims whose payment this bill now requires. 
feat_title: Home Health Documentation and Program Improvement Act of 2015