The House Ways and Means Committee has endorsed a bipartisan bill that would require agencies to obtain a minimum of $50,000 in surety bond coverage, similar to surety bonds that have been required of home medical equipment (HME) suppliers since 2009.
 
A floor vote in favor of the bill, which cleared the key Medicare committee on Feb. 26, is expected, House aides say.
 
Intended to strengthen the government’s efforts to block Medicare fraud, the “Protecting the Integrity of Medicare Act” would have other consequences for the home health industry. For one thing, the bill would allow CMS to set a higher bond amount than $50,000 should it decide on a larger amount “commensurate with the volume of payments to the home health agency.”
 
The bill (H.R. 1021) rejects proposed options to soften the impact of its surety bond requirement. For example, it doesn’t limit the requirement to a maximum period of three years, as recommended by the General Accountability Office (HHL 8/25/14).
 
The bill also wouldn’t limit the surety bond to serving as a fraud-prevention screen intended to bar inappropriate providers from Medicare participation, as urged by the National Association for Home Care & Hospice (NAHC). Neither does it adopt another NAHC idea that the bond be considered insurance against overpayments that have not been recouped.
 
The bill also doesn’t strengthen admission standards for new Medicare home health agencies through probationary initial enrollment, prepayment claims review, increased initial capitalization requirements, and early-intervention oversight by Medicare surveyors, as NAHC urged. In lobbying instructions to members, the home health association urges them to remind lawmakers that the bill’s surety bond provision “will hurt small home health businesses and threaten access to care.”
 
Other bill provisions affecting home health:
 
  • Face-to-face compliance for HME would be eased by allowing more disciplines to conduct the encounters. If state law permits, nurse practitioners and physician assistants could perform the necessary patient encounters along with physicians, who now are the only professionals CMS allows to document the eligibility of referred patients for HME.
  • Up to 15% of payments recouped by Medicare administrative contractors (MACs) would be reserved for “an improper payment outreach and education program.” The program would advise providers and suppliers of their “most frequent and expensive payment errors” and new targets approved for audits by recovery audit contractors (RACs).