Medicare Hospice Benefit Amendments of 1996

Summary: Medicare Hospice Benefit Amendments of 1996 - Amends title XVIII (Medicare) of the Social Security Act with respect to hospice care to:  (1) restructure the hospice care benefit period; (2) cover ambulance services, diagnostic tests, and anticancer chemotherapy and radiation therapy services; (3) permit contracting with independent physicians or physician groups for hospice care services; (4) allow waiver of certain staffing requirements for hospice care programs in non-urbanized areas; (5) define coverage denial, with respect to the limitation on the liability of beneficiaries and providers, to mean a determination that an individual is not terminally ill; and (6) extend the period for physician certification of an individual's terminal illness.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Hospice Benefit Amendments 
of 1996''.

SEC. 2. HOSPICE CARE BENEFIT PERIODS.

    (a) Restructuring of Benefit Period.--Section 1812 of the Social 
Security Act (42 U.S.C. 1395d) is amended in subsections (a)(4) and 
(d)(1), by striking ``, a subsequent period of 30 days, and a 
subsequent extension period'' and inserting ``and an unlimited number 
of subsequent periods of 60 days each''.
    (b) Conforming Amendments.--(1) Section 1812 of such Act (42 U.S.C. 
1395d) is amended in subsection (d)(2)(B) by striking ``90- or 30-day 
period or a subsequent extension period'' and inserting ``90-day period 
or a subsequent 60-day period''.
    (2) Section 1814(a)(7)(A) of such Act (42 U.S.C. 1395f(a)(7)(A)) is 
amended--
            (A) in clause (i), by inserting ``and'' at the end;
            (B) in clause (ii)--
                    (i) by striking ``30-day'' and inserting ``60-
                day''; and
                    (ii) by striking ``and'' at the end and inserting a 
                period; and
            (C) by striking clause (iii).

SEC. 3. AMBULANCE SERVICES, DIAGNOSTIC TESTS, CHEMOTHERAPY SERVICES, 
              AND RADIATION THERAPY SERVICES INCLUDED IN HOSPICE CARE.

    Section 1861(dd)(1) of the Social Security Act (42 U.S.C. 
1395x(dd)(1)) is amended--
            (1) in subparagraph (E), by inserting ``anticancer 
        chemotherapeutic agents and other'' before ``drugs'';
            (2) in subparagraph (G), by striking ``and'' at the end;
            (3) in subparagraph (H), by striking the period at the end 
        and inserting a comma; and
            (4) by inserting after subparagraph (H) the following:
            ``(I) ambulance services,
            ``(J) diagnostic tests, and
            ``(K) radiation therapy services.''.

SEC. 4. CONTRACTING WITH INDEPENDENT PHYSICIANS OR PHYSICIAN GROUPS FOR 
              HOSPICE CARE SERVICES PERMITTED.

    Section 1861(dd)(2) of the Social Security Act (42 U.S.C. 
1395x(dd)(2)) is amended--
            (1) in subparagraph (A)(ii)(I), by striking ``(F),''; and
            (2) in subparagraph (B)(i), by inserting ``or under 
        contract with'' after ``employed by''.

SEC. 5. WAIVER OF CERTAIN STAFFING REQUIREMENTS FOR HOSPICE CARE 
              PROGRAMS IN NON-URBANIZED AREAS.

    Section 1861(dd)(5) of the Social Security Act (42 U.S.C. 
1395x(dd)(5)) is amended--
            (1) in subparagraph (B), by inserting ``or (C)'' after 
        ``subparagraph (A)'' each place it appears; and
            (2) by adding at the end the following:
    ``(C) The Secretary may waive the requirements of paragraph 
(2)(A)(i) and (2)(A)(ii) for an agency or organization with respect to 
the services described in paragraph (1)(B) and, with respect to dietary 
counseling, paragraph (1)(H), if such agency or organization--
            ``(i) is located in an area which is not an urbanized area 
        (as defined by the Bureau of Census), and
            ``(ii) demonstrates to the satisfaction of the Secretary 
        that the agency or organization has been unable, despite 
        diligent efforts, to recruit appropriate personnel.''.

SEC. 6. LIMITATION ON LIABILITY OF BENEFICIARIES AND PROVIDERS FOR 
              CERTAIN HOSPICE COVERAGE DENIALS.

    (a) In General.--Section 1879(g) of the Social Security Act (42 
U.S.C. 1395pp(g)) is amended--
            (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively, and moving such 
        subparagraphs 2 ems to the right;
            (2) by striking ``is,'' and inserting ``is--'';
            (3) by making the remaining text of subsection (g), as 
        amended, that follows ``is--'' a new paragraph (1) and 
        indenting such paragraph 2 ems to the right;
            (4) by striking the period at the end and inserting ``; 
        and''; and
            (5) by adding at the end the following new paragraph:
            ``(2) with respect to the provision of hospice care to an 
        individual, a determination that the individual is not 
        terminally ill.''.
    (b) Waiver Period Extended.--Section 9305(f)(2) of the Omnibus 
Budget Reconciliation Act of 1986 is amended by striking ``and before 
December 31, 1995.''.
    (c) Effective Date.--The amendments made by this section take 
effect December 31, 1995.

SEC. 7. EXTENDING THE PERIOD FOR PHYSICIAN CERTIFICATION OF AN 
              INDIVIDUAL'S TERMINAL ILLNESS.

    Section 1814(a)(7)(A)(i)(II) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(A)(i)(II)) is amended by striking ``, not later than 2 days 
after hospice care is initiated (or, if each certify verbally not later 
than 2 days after hospice care is initiated, not later than 8 days 
after such care is initiated),'' and inserting ``at the beginning of 
the period''.

SEC. 8. EFFECTIVE DATE.

    Except as provided in section 6(c), the amendments made by this Act 
apply to benefits provided on or after the date of the enactment of 
this Act, regardless of whether or not an individual has made an 
election under section 1812(d) of the Social Security Act before such 
date.