text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Home Health Documentation and 
  Program Improvement Act of 2017''.
  
  SEC. 2. INFORMATION TO SATISFY DOCUMENTATION OF MEDICARE ELIGIBILITY 
                FOR HOME HEALTH SERVICES.
  
      (a) Part A.--Section 1814(a) of the Social Security Act (42 U.S.C. 
  1395f(a)) is amended by inserting before ``For purposes of paragraph 
  (2)(C),'' the following new sentence: ``For purposes of documentation 
  for physician certification and recertification made under paragraph 
  (2) on or after January 1, 2018, and made with respect to home health 
  services furnished by a home health agency, in addition to using 
  documentation in the medical record of the physician who so certifies 
  or the medical record of the acute or post-acute care facility (in the 
  case that home health services were furnished to an individual who was 
  directly admitted to the home health agency from such a facility), the 
  Secretary shall use documentation in the medical record of the home 
  health agency as supporting material, as appropriate to the case 
  involved.''.
      (b) Part B.--Section 1835(a) of the Social Security Act (42 U.S.C. 
  1395n(a)) is amended by inserting before ``For purposes of paragraph 
  (2)(A),'' the following new sentence: ``For purposes of documentation 
  for physician certification and recertification made under paragraph 
  (2) on or after January 1, 2018, and made with respect to home health 
  services furnished by a home health agency, in addition to using 
  documentation in the medical record of the physician who so certifies 
  or the medical record of the acute or post-acute care facility (in the 
  case that home health services were furnished to an individual who was 
  directly admitted to the home health agency from such a facility), the 
  Secretary shall use documentation in the medical record of the home 
  health agency as supporting material, as appropriate to the case 
  involved.''.
  
  SEC. 3. VOLUNTARY SETTLEMENT OF HOME HEALTH CLAIMS.
  
      (a) Settlement Process for Home Health Claims.--
              (1) In general.--Not later than one year after the date of 
          enactment of this Act, the Secretary of Health and Human 
          Services shall establish a settlement process under which a 
          home health agency entitled to an eligible administrative 
          appeal has the option to enter into a settlement with the 
          Secretary that is reached in a manner consistent with the 
          succeeding paragraphs of this subsection.
              (2) Process and consideration of home health claims.--A 
          settlement under paragraph (1) with a home health agency that 
          is with respect to an eligible administrative appeal may only 
          be reached in accordance with the following process:
                      (A) A settlement under such paragraph with the home 
                  health agency shall be with respect to all claims by 
                  such agency, subject to paragraph (4), that, as of the 
                  date of such settlement, are under an eligible 
                  administrative appeal.
                      (B) For the duration of the settlement process with 
                  such agency, an eligible administrative appeal that is 
                  with respect to any such claim by such agency shall be 
                  suspended.
                      (C) Under the settlement process, the Secretary 
                  shall determine an aggregate amount to be paid to the 
                  home health agency with respect to all claims by such 
                  agency that are under an eligible administrative appeal 
                  in the following manner:
                              (i) The Secretary shall, for purposes of 
                          applying clause (ii) with respect to all 
                          settlements under paragraph (1), select a 
                          percentage. In selecting such percentage, the 
                          Secretary shall consider the percentage used 
                          under the Centers for Medicare & Medicaid 
                          Services hospital appeals settlement that began 
                          on October 31, 2014.
                              (ii) The Secretary shall, with respect to 
                          each denied claim for such agency that is under 
                          an eligible administrative appeal, calculate an 
                          amount (referred to in this subparagraph as an 
                          ``individual claim amount'') by multiplying the 
                          net payable amount for such claim by the 
                          percentage selected under clause (i).
                              (iii) Such aggregate amount with respect to 
                          such agency shall be determined by calculating 
                          the total sum of all the individual claim 
                          amounts calculated under clause (ii) with 
                          respect to such agency.
              (3) Effect of process.--
                      (A) Effect of settlement.--
                              (i) Further appeal.--As part of any 
                          settlement under paragraph (1) between a home 
                          health agency and the Secretary, such home 
                          health agency shall be required to forego the 
                          right to an administrative appeal under section 
                          1869 of the Social Security Act (42 U.S.C. 
                          1395ff) or section 1878 of such Act (42 U.S.C. 
                          1395oo) (including any redetermination, 
                          reconsideration, hearing, or review) with 
                          respect to any claims for home health services 
                          that are subject to the settlement.
                              (ii) Judicial review.--There shall be no 
                          administrative or judicial review under such 
                          section 1869 or otherwise of a settlement under 
                          paragraph (1) and the claims covered by the 
                          settlement.
                      (B) Effect of no settlement.--In the event that the 
                  process described in paragraph (2) does not, with 
                  respect to a home health agency, result in a settlement 
                  under paragraph (1) with such agency, any appeal under 
                  such section 1869 that is with respect to a claim by 
                  such agency that was suspended pursuant to paragraph 
                  (2)(B) shall resume under such section.
              (4) Coordination with law enforcement.--The Secretary of 
          Health and Human Services shall establish a process under which 
          individuals in the Department of Health and Human Services 
          responsible for executing a settlement under paragraph (1) may, 
          in order to avoid the inadvertent settlement of cases that 
          involve fraud or other criminal activity, coordinate with 
          appropriate law enforcement agencies.
      (b) No Entitlement to Settlement Process.--Nothing in this section 
  shall be construed as creating an entitlement to enter into a 
  settlement process established pursuant to subsection (a).
      (c) Eligible Administrative Appeal Defined.--For purposes of this 
  section, the term ``eligible administrative appeal'' means an appeal 
  under section 1869 of the Social Security Act (42 U.S.C. 1395ff) 
  (including any redetermination, reconsideration, hearing, or review)--
              (1) that is with respect to one or more claims that--
                      (A) are for home health services that--
                              (i) were furnished on or after January 1, 
                          2011, and before January 1, 2015; and
                              (ii) were reasonable and necessary under 
                          section 1862(a)(1)(A) of such Act (42 U.S.C. 
                          1395y(a)(1)(A)); and
                      (B) were timely filed consistent with section 
                  1814(a)(1) of such Act (42 U.S.C. 1395f(a)(1)) or 
                  sections 1835(a)(1) and 1842(b)(3) of such Act (42 
                  U.S.C. 1395n(a)(1), 1395u(b)(3)); and
              (2) either--
                      (A) was timely filed consistent with section 1869 
                  of such Act (42 U.S.C. 1395ff) and is pending; or
                      (B) for which the applicable time frame to file an 
                  appeal has not expired.
      (d) Conforming Amendment.--Section 1869 of the Social Security Act 
  (42 U.S.C. 1395ff) is amended by adding at the end the following new 
  subsection:
      ``(j) Application With Respect to Certain Home Health Claims.--For 
  the application of the provisions of this section with respect to 
  certain claims for home health services that were furnished on or after 
  January 1, 2011, and before January 1, 2015, see section 3 of the Home 
  Health Documentation and Program Improvement Act of 2017.''.
target: Home Health Documentation and Program Improvement Act of 2017 This bill requires&nbsp;the Centers for Medicare &amp; Medicaid Services (CMS)&nbsp;to use&nbsp;an individual's medical record&nbsp;from a home-health agency, as appropriate, to support certification of such individual's Medicare eligibility for&nbsp;home-health services. The bill requires the CMS to establish a process for home-health agencies that are entitled to an administrative appeal after being denied eligibility for Medicare reimbursement to, instead, enter into a settlement with the CMS. 
feat_title: Home Health Documentation and Program Improvement Act of 2017