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.

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).