[Congressional Record Volume 159, Number 74 (Thursday, May 23, 2013)]
[Senate]
[Page S3852]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WYDEN (for himself and Mr. Roberts):
  S. 1053. A bill to amend title XVIII of the Social Security Act to 
strengthen and protect Medicare hospice programs; to the Committee on 
Finance.
  Mr. WYDEN. 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. 1053

       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 of 2013''.

     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, nurse practitioner, clinical 
     nurse specialist, or 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 January 1, 2014, 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 paragraph (6)--
       (A) in subparagraph (D)--
       (i) in clause (i)--

       (I) in the first sentence, by striking ``not earlier than 
     October 1, 2013, the Secretary shall, by regulation,'' and 
     inserting ``subject to clause (iii), not earlier than the 
     later of 2 years after the demonstration program under 
     subparagraph (F) is completed or October 1, 2017, the 
     Secretary shall, by regulation, preceded by a 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 (F)(ii)'' before the period; and

       (ii) by adding at the end the following new clause:
       ``(iii) The Secretary shall implement the revisions in 
     payment pursuant to clause (i) unless the Secretary 
     determines that the demonstration program under subparagraph 
     (F) demonstrated that such revisions would adversely affect 
     access to quality hospice care by beneficiaries under this 
     title.''; and
       (B) by adding at the end the following new subparagraph:
       ``(F) Hospice payment reform demonstration program.--
       ``(i) Establishment of demonstration program.--
       ``(I) In general.--Before implementing any revisions to the 
     methodology for determining the payment rates for routine 
     home care and other services included in hospice care under 
     subparagraph (D), the Secretary shall establish a Medicare 
     Hospice Payment Reform demonstration program (in this 
     subparagraph referred to as the `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.--Any certified hospice program may apply to 
     participate in the demonstration program and the Secretary 
     shall select not more than 15 such hospice programs to 
     participate in the demonstration program.
       ``(IV) Representative participation.--Hospice programs 
     selected under subclause (III) to participate in the 
     demonstration program shall include a representative cross-
     section of hospice programs throughout the United States, 
     including programs located in urban and rural areas.
       ``(ii) Evaluation and report.--
       ``(I) Evaluation.--The Secretary shall conduct an 
     evaluation of the demonstration program. 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 
     care 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 2 years 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, the Secretary shall 
     ensure that revisions in payment implemented as part of the 
     demonstration program shall result in the same estimated 
     amount of aggregate payments under this title for hospice 
     care for the programs participating in the demonstration as 
     would have been made if the hospice programs had not 
     participated in the demonstration program.''.

     SEC. 4. HOSPICE SURVEY REQUIREMENT.

       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 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 beginning 6 months after the date of the 
     enactment of this subparagraph.''.
                                 ______