[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 722 Introduced in Senate (IS)]

112th CONGRESS
  1st Session
                                 S. 722

          To strengthen and protect Medicare hospice programs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 4, 2011

Mr. Wyden (for himself and Mr. Roberts) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 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.''.
                    (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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