NORMATIVE STANDARDS FOR HOME HEALTH CLAIMS DENIALS.

SEC. 4614. NORMATIVE STANDARDS FOR HOME HEALTH CLAIMS DENIALS. (a) In General.—Section 1862(a)(1) (42 U.S.C. 1395y(a)(1)) (as amended by section 4104(c)) is amended— (1) by striking “and” at the end of subparagraph (G), (2) by striking the semicolon at the end of subparagraph (H) and inserting “, and”, and (3) by inserting after subparagraph (H) the following new subparagraph: “(I) the frequency and duration of home health services which are in excess of normative guidelines that the Secretary shall establish by regulation;”. (b) Notification.—The Secretary of Health and Human Services may establish a process for notifying a physician in cases 111 STAT. 475in which the number of home health visits, furnished under title XVIII of the Social Security Act pursuant to a prescription or certification of the physician, significantly exceeds such threshold (or thresholds) as the Secretary specifies. The Secretary may adjust such threshold to reflect demonstrated differences in the need for home health services among different beneficiaries. (c) Effective Date.—The amendments made by this section apply to services furnished on or after October 1, 1997.