[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3506 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 3506

          To strengthen and protect Medicare hospice programs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 22, 2011

  Mr. Reed (for himself, Mr. Paulsen, and Mr. Thompson of California) 
 introduced the following bill; which was referred to the Committee on 
    Ways and Means, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
          To strengthen and protect Medicare hospice programs.

    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 ``Hospice Evaluation and Legitimate 
Payment Act''.

SEC. 2. ENSURING TIMELY ACCESS TO HOSPICE CARE.

    (a) In General.--Section 1814(a)(7)(D)(i) of the Social Security 
Act (42 U.S.C. 1395f(a)(7)(D)(i)) is amended to read as follows:
                            ``(i) a hospice physician, a nurse 
                        practitioner, a clinical nurse specialist, or a 
                        physician assistant (as those terms are defined 
                        in section 1861(aa)(5)), or other health 
                        professional (as designated by the Secretary), 
                        has a face-to-face encounter with the 
                        individual to determine continued eligibility 
                        of the individual for hospice care prior to the 
                        first 60-day period and each subsequent 
                        recertification under subparagraph (A)(ii) (or, 
                        in the case where a hospice program newly 
                        admits an individual who would be entering 
                        their first 60-day period or a subsequent 
                        hospice benefit period or where exceptional 
                        circumstances, as defined by the Secretary, may 
                        prevent a face-to-face encounter prior to the 
                        beginning of the hospice benefit period, not 
                        later than 7 calendar days after the 
                        individual's election under section 1812(d)(1) 
                        with respect to the hospice program) and 
                        attests that such visit took place (in 
                        accordance with procedures established by the 
                        Secretary); and''.
    (b) Effective Date.--The amendment made by subsection (a) takes 
effect on the date of enactment of this Act and applies to hospice care 
furnished on or after such date.

SEC. 3. RESTORING AND PROTECTING THE MEDICARE HOSPICE BENEFIT.

    (a) In General.--Section 1814(i) of the Social Security Act (42 
U.S.C. 1395f(i)) is amended--
            (1) in subparagraph (1)(C)--
                    (A) in clause (ii)--
                            (i) in the matter preceding subclause (I), 
                        by striking ``(6)(D)'' and inserting 
                        ``(6)(E)''; and
                            (ii) in subclause (VII), by striking 
                        ``(6)(D)'' and inserting ``(6)(E)''; and
                    (B) in clause (iii), by moving such clause 6 ems to 
                the left and striking ``(6)(D)'' and inserting 
                ``(6)(E)''; and
            (2) in paragraph (6)--
                    (A) in subparagraph (A), by striking ``subparagraph 
                (D)'' and inserting ``subparagraph (E)'';
                    (B) by redesignating subparagraphs (D) and (E) as 
                subparagraphs (E) and (F), respectively, and inserting 
                after subparagraph (C) the following new subparagraph:
            ``(D) Hospice payment reform demonstration program.--
                    ``(i) Establishment of demonstration program.--
                            ``(I) In general.--Prior to implementing 
                        any revisions to the methodology for 
                        determining the payment rates for routine home 
                        care and other services included in hospice 
                        care under subparagraph (E), the Secretary 
                        shall establish a Medicare Hospice Payment 
                        Reform demonstration program to test such 
                        proposed revisions.
                            ``(II) Duration.--The demonstration program 
                        shall be conducted for a 2-year period 
                        beginning on or after October 1, 2013.
                            ``(III) Scope.--The Secretary shall select 
                        not more than 15 hospice programs at which the 
                        demonstration program under this subparagraph 
                        shall be conducted.
                            ``(IV) Representative participation.--
                        Hospice programs selected under subclause (III) 
                        to participate in the demonstration program 
                        shall include a representative cross-section of 
                        such programs throughout the United States, 
                        including programs located in urban and rural 
                        areas.
                            ``(V) Voluntary participation.--Hospice 
                        program participation in the demonstration 
                        program shall be on a voluntary basis.
                    ``(ii) Evaluation and report.--
                            ``(I) Evaluation.--The Secretary shall 
                        conduct an evaluation of the demonstration 
                        program under this subparagraph. Such 
                        evaluation shall include an analysis of whether 
                        the use of the revised payment methodology 
                        under the demonstration program has improved 
                        the quality of patient care and access to 
                        hospice services for beneficiaries under this 
                        title and the impact of such payment revisions 
                        on hospice care providers, including the 
                        impact, if any, on the ability of hospice 
                        programs to furnish quality care to 
                        beneficiaries under this title.
                            ``(II) Report.--Not later than 1 year after 
                        the completion of the demonstration program, 
                        the Secretary shall submit to Congress a report 
                        containing the results of the evaluation 
                        conducted under subclause (I), together with 
                        recommendations for such legislation and 
                        administrative action as the Secretary 
                        determines appropriate.
                    ``(iii) Budget neutrality.--With respect to the 2-
                year period of the demonstration program under this 
                subparagraph, the Secretary shall ensure that the 
                estimated amount of aggregate payments under this title 
                to each hospice program participating in the 
                demonstration program for such period shall not be more 
                than 5 percent higher or 5 percent lower than the 
                estimated amount of aggregate payments that would have 
                been made under this title to each such hospice program 
                during such period had they not participated in the 
                demonstration program under this subparagraph.'';
                    (C) in subparagraph (E), as redesignated by 
                subparagraph (B)--
                            (i) in clause (i)--
                                    (I) in the first sentence, by 
                                striking ``October 1, 2013, the 
                                Secretary shall, by regulation'' and 
                                inserting ``subject to clause (iii), 
                                the later of 2 years after the 
                                demonstration program under 
                                subparagraph (D) is completed or 
                                October 1, 2017, the Secretary shall, 
                                by regulation, preceded by notice of 
                                the proposed regulation in the Federal 
                                Register and a period for public 
                                comment in accordance with section 
                                1871(b)(1),''; and
                                    (II) in the second sentence, by 
                                inserting ``, and shall take into 
                                account the results of the evaluation 
                                conducted under subparagraph (D)(ii)'' 
                                before the period; and
                            (ii) by adding at the end the following new 
                        clause:
                    ``(iii) In no case may the Secretary implement any 
                revisions in payment pursuant to clause (i) unless the 
                Secretary determines that the demonstration program 
                under subparagraph (D) demonstrated that such revisions 
                would not adversely affect access to quality hospice 
                care by beneficiaries under this title.''; and
                    (D) in subparagraph (F), as redesignated by 
                subparagraph (B), by striking ``subparagraph (D)'' and 
                inserting ``subparagraph (E)''.

SEC. 4. HOSPICE SURVEY REQUIREMENT.

    (a) In General.--Section 1861(dd)(4) of the Social Security Act (42 
U.S.C. 1395x(dd)(4)) is amended by adding at the end the following new 
subparagraph:
    ``(C) Any entity seeking certification as a hospice program shall 
be subject to an initial survey by an appropriate State or local survey 
agency, or an approved accreditation agency, as determined by the 
Secretary, not later than 6 months after beginning operations, and any 
entity which is certified as a hospice program shall be subject to a 
standard survey not less frequently than every 36 months.''.
    (b) Effective Date.--The amendment made by subsection (a) takes 
effect on the date that is 180 days after the date of enactment of this 
Act and applies to hospice programs on or after such date.
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