1.This Act may be cited as
the Hospice Evaluation and Legitimate
Payment Act
.
2.Ensuring timely
access to hospice care
(a)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)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.
3.Restoring and
protecting the medicare hospice benefit
(a)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)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)The
demonstration program shall be conducted for a 2-year period beginning on or
after October 1, 2013.
(III)The
Secretary shall select not more than 15 hospice programs at which the
demonstration program under this subparagraph shall be conducted.
(IV)Representative
participationHospice 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)Hospice program participation in the demonstration
program shall be on a voluntary basis.
(ii)
(I)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)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)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)
.
4.Hospice survey
requirement
(a)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)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.