Medicare Home Health Services Improvement Act of 1987 - Amends title XVIII (Medicare) of the Social Security Act to permit patients to receive Medicare home health services on a daily basis for up to 60 days, and longer when the patient's physician certifies that exceptional circumstances require continued daily services.
Provides Medicare coverage of up to three weeks of post-hospital skilled and nonskilled home health care, as long as the cost of such benefits does not exceed the cost of care in a skilled nursing facility for an equivalent period of time.
Defines as "homebound" (a prerequisite of eligibility for Medicare home health services) any person who has a condition which restricts his or her ability to leave the home without support or for whom leaving the home is medically contraindicated.
Provides Medicare home health coverage for homebound individuals in need of occupational therapy. (Currently, occupational therapy is included only after an individual qualifies for home health services by reason of needing skilled nursing care or speech or physical therapy.)
Requires Medicare fiscal intermediaries which perform home health payment services to provide an explanation of claim denials for home health services and promptly notify the parties requesting a reconsideration of such determinations of the results of such reconsideration. Requires fiscal intermediaries to make partial payments of disputed claims when such notice has not been transmitted within 60 days of receipt of the reconsideration request. Makes an intermediary's performance on appeals of home health care payment determinations part of the Secretary of Health and Human Services' overall appraisal of the intermediary.
Requires a Medicare home health agency to: (1) protect and promote the rights of each individual under its care; (2) furnish the State licensing entity with the name and social security number of any individual hired by the agency as well as information as to whether such individual has been convicted of a felony; (3) inform the State licensing entity of changes in agency ownership or control; (4) furnish items and services through licensed health professionals or persons who have completed or are enrolled in a training program which meets minimum standards established by the Secretary by July 1988; and (5) include the patient's plan of care within its clinical records.
Requires an appropriate State or local agency to conduct a standard survey every nine to 15 months and upon a change in the ownership of, or significant number of complaints against, a home health agency, of the quality of patient care provided by such agencies. Subjects home health agencies which perform poorly on such surveys to an extended survey. Directs the Secretary to evaluate the assessment process, report to the Congress on the results of such evaluation, and make appropriate modifications to such process by 1992.
Requires the Secretary to develop and implement criteria and procedures for evaluating plans of correction submitted by home health agencies found out of compliance with Medicare participation requirements. Authorizes the Secretary to impose intermediate sanctions on agencies whose failure to correct deficiencies pursuant to approved plans of correction does not immediately jeopardize the health and safety of health care beneficiaries.
Requires the Secretary to promulgate major Medicare rules, requirements, or policy statements through the regulatory process. Sets forth publication requirements.
Directs the Secretary to publish and make available to the public without charge a directory of home health agencies certified to participate in the Medicare program, including certain information gathered with respect to each agency during the latest certification survey.
Requires appropriate State or local agencies to maintain: (1) toll-free hotlines to receive complaints and answer questions regarding home health agencies in the State or locality; and (2) units with enforcement authority and access to consumer medical records and survey reports to investigate such complaints.
Directs the Secretary to: (1) report to the Congress before 1988 on the appropriateness of reimbursing home health agencies on either a rural or urban basis rather than considering an agencies mix of urban and rural clientele; and (2) determine home health agency cost limits on the basis of recent agency cost reports.
Introduced in Senate
Read twice and referred to the Committee on Finance.
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