Medicare Home Health Payment Integrity Act Introduced

WASHINGTON—Newly introduced legislation is aiming to protect the Medicare home health program from fraud and strengthen access to services. The Medicare Home Health Payment Integrity and Protection Act would give the Centers for Medicare & Medicaid Services (CMS) additional tools to prevent and detect fraud while helping ensure that legitimate home health agencies are fairly reimbursed for the care they provide.

The bill, HR 8804, was introduced by Sen. Susan Collins.

“When billions of dollars are improperly siphoned from the Medicare home health program, this can undermine the integrity of the payment system used to reimburse legitimate providers and threaten care for the seniors who depend on it,” said Collins. “I have long been a strong supporter of home healthcare, which allows millions of Americans to remain in the comfort, security and privacy of their own homes, while helping to avoid unnecessary hospitalizations and nursing home admissions. Fraudulent home health providers harm beneficiaries and diminish reimbursements for honest agencies that are already confronting workforce shortages and rising costs. My legislation would give CMS stronger tools to stop fraud before payments are made and prevent fraudulent spending from distorting the data used to reimburse honest agencies for medically necessary care.”

Specifically, the legislation would:

• Require that the identity of home health administrators be verified before agencies are enrolled and authorized to provide services;
• Require proof of liability insurance for agencies that exhibit high risk of fraud;
• Provide the administrator with the authority to determine the factors that indicate that an agency presents an extreme risk of fraud, and to impose heightened screening requirements on such agencies;
• Require much more frequent surveys of newly enrolled home health agencies, agencies that undergo ownership changes and agencies that reactivate their billing privileges;
• Increase inspections of home health agencies that fail to submit quality data to CMS, or that engage in practices that are aberrant or signal fraudulent behavior;
• Increase financial penalties for failing to report quality data;
• Require accrediting agencies that work with CMS to meet or exceed CMS standards;
• Require CMS training of home health surveyors for accreditation purposes;
• Establish ongoing CMS oversight of accrediting organizations and provide CMS with authority to terminate deficient accreditors;
• Direct CMS to “reset” home health agency payment rates to adjust for fraud in the system as well as changes in the use of home healthcare since COVID-19;
• Authorize funding for CMS and federal law enforcement agencies for the investigation and prosecution of organized home health fraud schemes;
• Authorize funding for CMS and its state agency partners to conduct accelerated surveys, enrollment validation, unannounced site visits and operational verification of home health agencies; and
• Provide CMS with rulemaking authority to carry out its provisions and require it to report to Congress.
   

The bill has received praise from several home health organizations including the National Alliance for Care at Home (the Alliance), which said it strongly supports the bill for its payment reforms and measures to protect patients. 

This bill corrects longstanding flaws in home health reimbursement and takes a meaningful step toward a home health benefit that is stable and built for how care is delivered today,”  said Jennifer Sheets, CEO of the Alliance. “Consistent with our community’s commitment to provide the highest-quality, person-centered care in the home, we support the bill’s goal to strengthen access while focusing on targeted oversight, protecting the legitimate providers who serve patients every day.”

Katie Smith Sloan, president and CEO of LeadingAge, also released a statement in support of the bill.

“Sen. Collins’ bill rightly seeks to rectify two contributors to that unfortunate situation: bad actors seeking to exploit the program, and a payment methodology that has produced years of reductions due to a flawed methodology,” Sloan said. “A longtime champion of Medicare home health, Senator Collins appreciates the shortcomings of current payment approaches; we are particularly encouraged by the bill’s recognition that the standard prospective payment amount requires a recalibration.”

Click here to read the complete text of the legislation.