[Congressional Record Volume 157, Number 47 (Monday, April 4, 2011)]
[Senate]
[Pages S2089-S2090]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. WYDEN (for himself and Mr. Roberts):
S. 722. A bill to strengthen and protect Medicare hospice programs;
to the Committee on Finance.
Mr. WYDEN. Mr. President, this is far from the first time I have
spoken in this Chamber about the importance of providing hospice
benefits and those workers who help provide them tirelessly every day.
Today I'm pleased to introduce legislation to strengthen the hospice
program so that these critical benefits will continue to be available
for those in the final stages of life.
Hospice care provides humane and comforting support for over 744,000
terminally ill patients and their families each year. These services
include pain control, palliative medical care and social, emotional and
spiritual services.
Hospice supports the basic human needs for feeling comfortable, in a
familiar environment, surrounded by loving caregivers and family during
the later stages of life. Hospice care is an effective model for the
interaction of interdisciplinary teams of health professionals, family
members and volunteers in providing care for those needing care in our
communities.
Our country strives to provide exceptional support for the sick,
elderly and terminally ill in home and hospice settings. These
vulnerable individuals, as well as their family caregivers, are
indebted to the many professionals and volunteers who have made it
their life's work to serve those in greatest need. Nearly 83,000
hospice professionals, 46,000 hospice volunteers and 1 million home
health providers, nationally, contribute significantly to our health
care system through their compassion and commitment.
It is because of these professionals and volunteers that seniors
continue to have access to this vital service. And it is with these
committed people in mind that Senator Roberts and I introduce
legislation that will help sustain the future of hospice care.
Specifically, The Hospice Evaluation and Legitimate Payment Act
creates a ``do no harm'' demonstration that evaluates proposed payment
changes to hospices at 15 different sites before going into effect.
With an estimated 66% of hospices looking down a road to negative
operating margins by 2019, Congress must act to ensure hospice doors
remain open. Testing payment changes can do that.
The HELP Act also allows nurse practitioners and physicians
assistants to sign-off on the required face-to-face encounter. This
expansion ensures program integrity while also preserving access to
services, especially in rural areas where great distances can create
unwanted impediments.
Finally, the HELP Act calls for increased accountability. Instead of
a hospice submitting a survey every eight years, this legislation
implements the recommendation of the OIG, and increases submission to
once every 3 years.
We need to support new ways to treat a very ill patient physically
and emotionally, long before the last days of life. We need to make
sure doctors are not afraid of using pain medications to make people
comfortable and, most of all, we need to make sure people start the
conversations with their families and doctors about having a better
death and using hospice as early as possible. None of these options for
changing the standards of end-of-life care delivery can occur if
hospices cannot continue to operate. The HELP Act makes that more
possible.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 722
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)'';
(B) in clause (iii), by moving such clause 6 ems to the
left and striking ``(6)(D)'' and inserting ``(6)(E)'';
(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
[[Page S2090]]
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.
Mr. ROBERTS. Mr. President, I rise today in support of the
legislation introduced by Senator Wyden, of which I am an original
cosponsor, the `Hospice Evaluation and Legitimate Payment Act.' The
HELP Act.
The HELP Act does what the title says it does and takes initial steps
in helping our hospices in Kansas and across the Nation continue to
give the valuable care that patients and families need.
It is impossible to describe the value of hospice services to the
patients and families for whom they provide selfless and compassionate
care. Over the next 10 years hospice is facing drastic reductions in
their reimbursements, negatively impacting at least 1.3 million
patients and families, which is the number served by hospice programs
in recent years.
The HELP Act sets realistic requirements for a face-to-face
encounter. The Accountable Care Act included a requirement that a
hospice physician or nurse practitioner should have a face-to-face
encounter with hospice patients before their 180-day recertification
and for each 60-day recertification period after that date, has caused
a significant burden on our hospice communities, especially those in
rural areas. The limits on who can conduct the face-to-face encounter
and the timeline for compliance do not reflect the operational
realities of hospice programs, especially for small and rural hospices.
The HELP Act would allow Nurse Practitioners, Clinical Nurse
Specialists and Physician's Assistants to conduct the face-to-face
encounter, and that hospice programs be afforded 7 days after the
election of services to fulfill the requirement.
The HELP Act would require the Secretary to establish a payment
reform demonstration program to test any prospective payment revisions
to hospice, and would include an evaluation period for data analysis;
increase the frequency of hospice surveys to every 3 years; and would
amend the new face-to-face encounter statutory framework to reflect
operational realities for hospice programs, and the needs of the
patients and families they serve.
Under this legislation the new payment methodologies for hospice must
first be piloted through a 2-year, 15-site demonstration program to
allow for any recommended payment reform schemes to be tested across a
representative sample of the hospice community and to assess their
impact on beneficiary access to hospice services.
The HELP Act also requires more frequent hospice surveys. A recent
Office of the Inspector General's, OIG, report noted that CMS was
remiss in its supervisory responsibilities by not regularly reviewing
the operational and clinical delivery processes of the hospice
community. OIG has recommended on numerous occasions that ``CMS should
conduct more frequent certification surveys of hospices as a way to
enforce the requirements.'' Accrediting organizations, such as the
Joint Commission for the Accreditation of Healthcare Organizations,
JCAHO, have set an industry standard of certification every 3 years for
hospices. The HELP Act requires an initial survey for those seeking
certification to be followed by a standard survey every 3 years.
While there is more work that needs to be done to address payment
reductions for hospice providers, the HELP Act takes some initial steps
to addressing these problems. I am grateful to my colleague Senator
Wyden for introducing this legislation and I am happy to lend my
support. I encourage all of my colleagues on both sides of the aisle to
review and consider supporting this very important piece of
legislation.
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