[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5821 Introduced in House (IH)]

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116th CONGRESS
  2d Session
                                H. R. 5821

 To amend title XVIII of the Social Security Act to establish hospice 
 program survey and enforcement procedures under the Medicare program, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 10, 2020

   Mr. Panetta (for himself, Mr. Reed, and Mr. Higgins of New York) 
 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 amend title XVIII of the Social Security Act to establish hospice 
 program survey and enforcement procedures under the Medicare program, 
                        and for other purposes.

    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 ``Helping Our Senior Population in 
Comfort Environments Act'' or the ``HOSPICE Act''.

SEC. 2. ESTABLISHING HOSPICE PROGRAM SURVEY AND ENFORCEMENT PROCEDURES 
              UNDER THE MEDICARE PROGRAM.

    (a) Survey and Enforcement Procedures.--
            (1) In general.--Part A of title XVIII of the Social 
        Security Act (42 U.S.C. 1395c et seq.) is amended by adding at 
        the end the following new section:

``SEC. 1822. HOSPICE PROGRAM SURVEY AND ENFORCEMENT PROCEDURES.

    ``(a) Surveys.--
            ``(1) Frequency.--Any entity that is certified as a hospice 
        program shall be subject to a standard survey by an appropriate 
        State or local survey agency, or an approved accreditation 
        agency, as determined by the Secretary, not less frequently 
        than once every 36 months (and not less frequently than once 
        every 24 months beginning October 1, 2021).
            ``(2) Public transparency of survey and certification 
        information.--
                    ``(A) Submission of information to the secretary.--
                            ``(i) In general.--Each State, and each 
                        national accreditation body with respect to 
                        which the Secretary has made a finding under 
                        section 1865(a) respecting the accreditation of 
                        a hospice program by such body, shall submit, 
                        in a form and manner, and at a time, specified 
                        by the Secretary for purposes of this 
                        subparagraph, information respecting any survey 
                        or certification made with respect to a hospice 
                        program by such State or body, as applicable. 
                        Such information shall include any inspection 
                        report made by such State or body with respect 
                        to such survey or certification, any 
                        enforcement actions taken as a result of such 
                        survey or certification, and any other 
                        information determined appropriate by the 
                        Secretary.
                            ``(ii) Required inclusion of specified 
                        form.--With respect to a survey under this 
                        subsection carried out by a national 
                        accreditation body described in clause (i) on 
                        or after October 1, 2021, information described 
                        in such clause shall include Form 2567 (or a 
                        successor form), along with such additional 
                        information determined appropriate by such 
                        body.
                    ``(B) Public disclosure of information.--Beginning 
                not later than October 1, 2022, the Secretary shall 
                publish the information submitted under subparagraph 
                (A) on the public website of the Centers for Medicare & 
                Medicaid Services in a manner that is prominent, easily 
                accessible, readily understandable, and searchable. The 
                Secretary shall provide for the timely update of such 
                information so published.
            ``(3) Consistency of surveys.--Each State and the Secretary 
        shall implement programs to measure and reduce inconsistency in 
        the application of survey results among surveyors.
            ``(4) Survey teams.--
                    ``(A) In general.--In the case of a survey 
                conducted under this subsection on or after October 1, 
                2021, by more than 1 individual, such survey shall be 
                conducted by a multidisciplinary team of professionals 
                (including a registered professional nurse).
                    ``(B) Prohibition of conflicts of interest.--
                Beginning October 1, 2021, a State may not use as a 
                member of a survey team under this subsection an 
                individual who is serving (or has served within the 
                previous 2 years) as a member of the staff of, or as a 
                consultant to, the program surveyed respecting 
                compliance with the requirements of section 1861(dd) or 
                who has a personal or familial financial interest in 
                the program being surveyed.
                    ``(C) Training.--The Secretary shall provide, not 
                later than October 1, 2021, for the comprehensive 
                training of State and Federal surveyors in the conduct 
                of surveys under this subsection, including training 
                with respect to the review of written plans for 
                providing hospice care (as described in section 
                1814(a)(7)(B)). No individual shall serve as a member 
                of a survey team with respect to a survey conducted on 
                or after such date unless the individual has 
                successfully completed a training and testing program 
                in survey and certification techniques that has been 
                approved by the Secretary.
            ``(5) Funding.--The Secretary shall provide for the 
        transfer, from the Federal Hospital Insurance Trust Fund under 
        section 1817 to the Centers for Medicare & Medicaid Program 
        Management Account, of $10,000,000 for each fiscal year 
        (beginning with fiscal year 2022) for purposes of carrying out 
        surveys under this subsection. Sums so transferred shall remain 
        available until expended. Any transfer pursuant to this 
        paragraph shall be in addition to any transfer pursuant to 
        section 3(a)(2) of the Improving Medicare Post-Acute Care 
        Transformation Act of 2014.
    ``(b) Special Focus Program.--
            ``(1) In general.--The Secretary shall conduct a special 
        focus program for enforcement of requirements for hospice 
        programs that the Secretary has identified as having 
        substantially failed to meet applicable requirements of this 
        Act.
            ``(2) Periodic surveys.--Under such special focus program, 
        the Secretary shall conduct surveys of each hospice program in 
        the special focus program not less than once every 6 months.
    ``(c) Enforcement.--
            ``(1) Situations involving immediate jeopardy.--If the 
        Secretary determines on the basis of a standard survey or 
        otherwise that a hospice program that is certified for 
        participation under this title is no longer in compliance with 
        the requirements specified in section 1861(dd) and determines 
        that the deficiencies involved immediately jeopardize the 
        health and safety of the individuals to whom the program 
        furnishes items and services, the Secretary shall take 
        immediate action to remove the jeopardy and correct the 
        deficiencies through the remedy described in paragraph 
        (5)(B)(iii) or terminate the certification of the program, and 
        may provide, in addition, for one or more of the other remedies 
        described in paragraph (5)(B).
            ``(2) Situations not involving immediate jeopardy.--If the 
        Secretary determines on the basis of a standard survey or 
        otherwise that a hospice program that is certified for 
        participation under this title is no longer in compliance with 
        the requirements specified in section 1861(dd) and determines 
        that the deficiencies involved do not immediately jeopardize 
        the health and safety of the individuals to whom the program 
        furnishes items and services, the Secretary may (for a period 
        not to exceed 6 months) impose remedies developed pursuant to 
        paragraph (5)(A), in lieu of terminating the certification of 
        the program. If, after such a period of remedies, the program 
        is still no longer in compliance with such requirements, the 
        Secretary shall terminate the certification of the program.
            ``(3) Penalty for previous noncompliance.--If the Secretary 
        determines that a hospice program that is certified for 
        participation under this title is in compliance with the 
        requirements specified in section 1861(dd) but, as of a 
        previous period, did not meet such requirements, the Secretary 
        may provide for a civil monetary penalty under paragraph 
        (5)(B)(i) for the days in which the Secretary finds that the 
        program was not in compliance with such requirements.
            ``(4) Option to continue payments for noncompliant hospice 
        programs.--The Secretary may continue payments under this title 
        with respect to a hospice program not in compliance with the 
        requirements specified in section 1861(dd) over a period of not 
        longer than 6 months, if--
                    ``(A) the State or local survey agency finds that 
                it is more appropriate to take alternative action to 
                assure compliance of the program with such requirements 
                than to terminate the certification of the program;
                    ``(B) the program has submitted a plan and 
                timetable for corrective action to the Secretary for 
                approval and the Secretary approves the plan of 
                corrective action; and
                    ``(C) the program agrees to repay to the Federal 
                Government payments received under this title during 
                such period if the corrective action is not taken in 
                accordance with the approved plan and timetable.
        The Secretary shall establish guidelines for approval of 
        corrective actions requested by hospice programs under this 
        paragraph.
            ``(5) Remedies.--
                    ``(A) Development.--
                            ``(i) In general.--Not later than October 
                        1, 2021, the Secretary shall develop and 
                        implement--
                                    ``(I) a range of remedies to apply 
                                to hospice programs under the 
                                conditions described in paragraphs (1) 
                                through (4); and
                                    ``(II) appropriate procedures for 
                                appealing determinations relating to 
                                the imposition of such remedies.
                        Remedies developed pursuant to the preceding 
                        sentence shall include the remedies specified 
                        in subparagraph (B).
                            ``(ii) Conditions of imposition of 
                        remedies.--Not later than October 1, 2021, the 
                        Secretary shall develop and implement specific 
                        procedures with respect to the conditions under 
                        which each of the remedies developed under 
                        clause (i) is to be applied, including the 
                        amount of any fines and the severity of each of 
                        these remedies. Such procedures shall be 
                        designed so as to minimize the time between 
                        identification of deficiencies and imposition 
                        of these remedies and shall provide for the 
                        imposition of incrementally more severe fines 
                        for repeated or uncorrected deficiencies.
                    ``(B) Specified remedies.--The remedies specified 
                in this subparagraph are the following:
                            ``(i) Civil monetary penalties in an amount 
                        not to exceed $10,000 for each day of 
                        noncompliance by a hospice program with the 
                        requirements specified in section 1861(dd).
                            ``(ii) Suspension of all or part of the 
                        payments to which a hospice program would 
                        otherwise be entitled under this title with 
                        respect to items and services furnished by a 
                        hospice program on or after the date on which 
                        the Secretary determines that remedies should 
                        be imposed pursuant to paragraph (2).
                            ``(iii) The appointment of temporary 
                        management to oversee the operation of the 
                        hospice program and to protect and assure the 
                        health and safety of the individuals under the 
                        care of the program while improvements are made 
                        in order to bring the program into compliance 
                        with all such requirements.
                    ``(C) Procedures.--
                            ``(i) Civil monetary penalties.--
                                    ``(I) In general.--Subject to 
                                subclause (II), the provisions of 
                                section 1128A (other than subsections 
                                (a) and (b)) shall apply to a civil 
                                monetary penalty under this subsection 
                                in the same manner as such provisions 
                                apply to a penalty or proceeding under 
                                section 1128A(a).
                                    ``(II) Retention of amounts for 
                                hospice program improvements.--The 
                                Secretary may provide that any portion 
                                of civil monetary penalties collected 
                                under this subsection may be used to 
                                support activities that benefit 
                                individuals receiving hospice care, 
                                including education and training 
                                programs to ensure hospice program 
                                compliance with the requirements of 
                                section 1861(dd).
                            ``(ii) Suspension of payment.--A finding to 
                        suspend payment under subparagraph (B)(ii) 
                        shall terminate when the Secretary finds that 
                        the program is in substantial compliance with 
                        all such requirements.
                            ``(iii) Temporary management.--The 
                        temporary management under subparagraph 
                        (B)(iii) shall not be terminated until the 
                        Secretary has determined that the program has 
                        the management capability to ensure continued 
                        compliance with all the requirements referred 
                        to in such subparagraph.
                    ``(D) Relationship to other remedies.--The remedies 
                developed under subparagraph (A) are in addition to 
                sanctions otherwise available under State or Federal 
                law and shall not be construed as limiting other 
                remedies, including any remedy available to an 
                individual at common law.''.
            (2) Availability of hospice accreditation surveys.--Section 
        1865(b) of the Social Security Act (42 U.S.C. 1395bb(b)) is 
        amended by inserting ``or, beginning on the date of the 
        enactment of the HOSPICE Act, a hospice program'' after ``home 
        health agency''.
            (3) State provision of hospice program information.--
                    (A) In general.--Section 1864(a) of the Social 
                Security Act (42 U.S.C. 1395aa(a)) is amended in the 
                sixth sentence--
                            (i) by inserting ``and hospice programs'' 
                        after ``information on home health agencies'';
                            (ii) by inserting ``or the hospice 
                        program'' after ``the home health agency'';
                            (iii) by inserting ``or the hospice 
                        program'' after ``with respect to the agency''; 
                        and
                            (iv) by inserting ``and hospice programs'' 
                        after ``with respect to home health agencies''.
                    (B) Effective date.--The amendments made by 
                subparagraph (A) shall apply with respect to agreements 
                entered into on or after, or in effect as of, the date 
                that is 1 year after the date of the enactment of this 
                Act.
            (4) Conforming amendments.--
                    (A) Definition of a hospice program.--Section 
                1861(dd)(4) of the Social Security Act (42 U.S.C. 
                1395x(dd)(4)) is amended by striking subparagraph (C).
                    (B) Continuation of funding.--Section 3(a)(2) of 
                the Improving Medicare Post-Acute Care Transformation 
                Act of 2014 is amended by inserting ``and section 
                1822(a)(1) of such Act,'' after ``as added by paragraph 
                (1),''.
    (b) Increasing Payment Reductions for Failure To Meet Quality Data 
Reporting Requirements.--Section 1814(i)(5)(A)(i) of the Social 
Security Act (42 U.S.C. 1395f(i)(5)(A)(i)) is amended by inserting 
``(or, for fiscal year 2023 and each subsequent fiscal year, 4 
percentage points)'' before the period.
    (c) Report.--Not later than October 1, 2024, the Comptroller 
General of the United States shall submit to the Committee on Ways and 
Means of the House of Representatives and the Committee on Finance of 
the Senate a report containing an analysis of the effects of the 
amendments made by subsection (a), including the frequency of 
application of remedies specified in section 1822(c)(5)(B) of the 
Social Security Act (as added by such subsection), on access to, and 
quality of, care furnished by hospice programs under part A of title 
XVIII of the Social Security Act (42 U.S.C. 1395c et seq.).
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