[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 2034 Introduced in Senate (IS)]







104th CONGRESS
  2d Session
                                S. 2034

To amend title XVIII of the Social Security Act to make certain changes 
              to hospice care under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 2, 1996

     Mr. Breaux (for himself, Mr. Mack, Mr. Graham, and Mr. Cohen) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to make certain changes 
              to hospice care under the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Hospice Benefit Amendments 
of 1996''.

SEC. 2. HOSPICE CARE BENEFIT PERIODS.

    (a) Restructuring of Benefit Period.--Section 1812 of the Social 
Security Act (42 U.S.C. 1395d) is amended in subsections (a)(4) and 
(d)(1), by striking ``, a subsequent period of 30 days, and a 
subsequent extension period'' and inserting ``and an unlimited number 
of subsequent periods of 60 days each''.
    (b) Conforming Amendments.--(1) Section 1812(d)(2)(B) of such Act 
(42 U.S.C. 1395d(d)(2)(B)) is amended by striking ``90- or 30-day 
period or a subsequent extension period'' and inserting ``90-day period 
or a subsequent 60-day period''.
    (2) Section 1814(a)(7)(A) of such Act (42 U.S.C. 1395f(a)(7)(A)) is 
amended--
            (A) in clause (i), by inserting ``and'' at the end;
            (B) in clause (ii)--
                    (i) by striking ``30-day'' and inserting ``60-
                day''; and
                    (ii) by striking ``and'' at the end and inserting a 
                period; and
            (C) by striking clause (iii).

SEC. 3. AMBULANCE SERVICES, DIAGNOSTIC TESTS, CHEMOTHERAPY SERVICES, 
              AND RADIATION THERAPY SERVICES INCLUDED IN HOSPICE CARE.

    Section 1861(dd)(1) of the Social Security Act (42 U.S.C. 
1395x(dd)(1)) is amended--
            (1) in subparagraph (E), by inserting ``anticancer 
        chemotherapeutic agents and other'' before ``drugs'';
            (2) in subparagraph (G), by striking ``and'' at the end;
            (3) in subparagraph (H), by striking the period at the end 
        and inserting a comma; and
            (4) by inserting after subparagraph (H) the following:
            ``(I) ambulance services,
            ``(J) diagnostic tests, and
            ``(K) radiation therapy services.''.

SEC. 4. CONTRACTING WITH INDEPENDENT PHYSICIANS OR PHYSICIAN GROUPS FOR 
              HOSPICE CARE SERVICES PERMITTED.

    Section 1861(dd)(2) of the Social Security Act (42 U.S.C. 
1395x(dd)(2)) is amended--
            (1) in subparagraph (A)(ii)(I), by striking ``(F),''; and
            (2) in subparagraph (B)(i), by inserting ``or under 
        contract with'' after ``employed by''.

SEC. 5. WAIVER OF CERTAIN STAFFING REQUIREMENTS FOR HOSPICE CARE 
              PROGRAMS IN NON-URBANIZED AREAS.

    Section 1861(dd)(5) of the Social Security Act (42 U.S.C. 
1395x(dd)(5)) is amended--
            (1) in subparagraph (B), by inserting ``or (C)'' after 
        ``subparagraph (A)'' each place it appears; and
            (2) by adding at the end the following:
    ``(C) The Secretary may waive the requirements of paragraphs 
(2)(A)(i) and (2)(A)(ii) for an agency or organization with respect to 
the services described in paragraph (1)(B) and, with respect to dietary 
counseling, paragraph (1)(H), if such agency or organization--
            ``(i) is located in an area which is not an urbanized area 
        (as defined by the Bureau of Census), and
            ``(ii) demonstrates to the satisfaction of the Secretary 
        that the agency or organization has been unable, despite 
        diligent efforts, to recruit appropriate personnel.''.

SEC. 6. LIMITATION ON LIABILITY OF BENEFICIARIES AND PROVIDERS FOR 
              CERTAIN HOSPICE COVERAGE DENIALS.

    (a) In General.--Section 1879(g) of the Social Security Act (42 
U.S.C. 1395pp(g)) is amended--
            (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively, and moving such 
        subparagraphs 2 ems to the right;
            (2) by striking ``is,'' and inserting ``is--'';
            (3) by making the remaining text of subsection (g), as 
        amended, that follows ``is--'' a new paragraph (1) and 
        indenting such paragraph 2 ems to the right;
            (4) by striking the period at the end and inserting ``; 
        and''; and
            (5) by adding at the end the following new paragraph:
            ``(2) with respect to the provision of hospice care to an 
        individual, a determination that the individual is not 
        terminally ill.''.
    (b) Waiver Period Extended.--Section 9305(f)(2) of the Omnibus 
Budget Reconciliation Act of 1986 is amended by striking ``and before 
December 31, 1995.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on December 31, 1995.

SEC. 7. EXTENDING THE PERIOD FOR PHYSICIAN CERTIFICATION OF AN 
              INDIVIDUAL'S TERMINAL ILLNESS.

    Section 1814(a)(7)(A)(i)(II) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(A)(i)(II)) is amended by striking ``, not later than 2 days 
after hospice care is initiated (or, if each certify verbally not later 
than 2 days after hospice care is initiated, not later than 8 days 
after such care is initiated),'' and inserting ``at the beginning of 
the period''.

SEC. 8. EFFECTIVE DATE.

    Except as provided in section 6(c), the amendments made by this Act 
shall apply to benefits provided on or after the date of the enactment 
of this Act, regardless of whether or not an individual has made an 
election under section 1812(d) of the Social Security Act before such 
date.
                                 <all>