Hospice Care Access Improvement Act of 2015

Summary: Hospice Care Access Improvement Act of 2015 This bill directs the Department of Health and Human Services (HHS) to select one Medicare administrative contractor to conduct a one-year demonstration program during FY2016 in all hospice programs under the contractor's jurisdiction to test revisions to the methodology for determining hospice payment rates under title XVIII (Medicare) of the Social Security Act contained in the &quot;Fiscal Year 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements,&quot; published on May 5, 2015, by the Centers for Medicare &amp; Medicaid Services. No revisions to the hospice payment methodology may be made for FY2016-FY2017, except for demonstration program purposes. HHS shall implement the proposed hospice payment methodology revisions beginning with FY2018 after:  taking into account an evaluation of the demonstration program, and making any necessary changes to the revisions.   HHS shall implement a process for the medical review of hospice care furnished by a hospice program identified according to certain multiple factors, such as the percentage of patients discharged after receiving hospice care for between 120 and 180 days and who were alive upon discharge. HHS shall also develop and publish guidance for hospice programs to develop interventions to reduce hospital admissions and visits to hospital emergency departments by hospice patients. Medicare shall cover pre-hospice evaluation and counseling services performed by a registered nurse employed by a hospice program. A skilled nursing facility (SNF) shall make a good faith effort to contract with more than one hospice program participating in the Medicare program that provides services in the area served by the SNF, if more than one hospice program is available to serve SNF residents. SNF residents shall have the right to be fully informed of any financial interest the SNF has in any hospice program to which a resident is referred. Any hospital discharge planning evaluation must evaluate, for an individual likely to need hospice care, the availability of such care through hospice programs that:  participate in the Medicare program and serve the area in which the patient resides, and request to be listed by the hospital as available. 

SECTION 1. SHORT TITLE.

    This Act may cited as the ``Hospice Care Access Improvement Act of 
2015''.

SEC. 2. HOSPICE PAYMENT REFORM DEMONSTRATION PROGRAM.

    (a) In General.--The Secretary of Health and Human Services (in 
this Act referred to as the ``Secretary'') shall conduct a 
demonstration program for a 1-year period during fiscal year 2016 to 
test the proposed hospice payment methodology revisions.
    (b) Proposed Hospice Payment Methodology Revisions Defined.--In 
this section, the term ``proposed hospice payment methodology 
revisions'' means revisions to the methodology for determining hospice 
payment rates under section 1814(i)(6)(D) of the Social Security Act 
(42 U.S.C. 1395f(i)(6)(D)) contained in the Fiscal Year 2016 Hospice 
Wage Index and Payment Rate Update and Hospice Quality Reporting 
Requirements as published by the Centers for Medicare & Medicaid 
Services on May 5, 2015 (80 Fed. Reg. 25831 et seq.).
    (c) Scope.--The Secretary shall select one Medicare administrative 
contractor to conduct the demonstration program. Such contractor shall 
conduct the demonstration program with respect to all hospice programs 
under that contractor's jurisdiction.
    (d) Evaluation.--The Secretary shall conduct an evaluation of the 
demonstration program, which shall include an analysis of the impact of 
the proposed hospice payment methodology revisions--
            (1) on the quality of patient care and the ability of 
        hospice programs to provide such care; and
            (2) on access to hospice care for beneficiaries.
    (e) Report.--Not later than March 31, 2017, the Secretary shall 
submit to Congress a report on the demonstration program. The report 
shall include--
            (1) the results of the evaluation under subsection (d); and
            (2) recommendations for such legislation and administrative 
        action as the Secretary determines appropriate.
    (f) Implementation of Hospice Payment Methodology Revisions.--
            (1) Prohibition on implementation of revisions for fiscal 
        years 2016 and 2017.--No revisions to the hospice payment 
        methodology shall be made under section 1814(i)(6)(D) of the 
        Social Security Act (42 U.S.C. 1395f(i)(6)(D)) for fiscal years 
        2016 and 2017, except for purposes of the demonstration program 
        required to be conducted under subsection (a).
            (2) Implementation of revisions for fiscal year 2018.--
        After taking into account the results of the evaluation of the 
        demonstration program and after making any necessary revisions, 
        the Secretary shall implement the proposed hospice payment 
        methodology revisions beginning with fiscal year 2018.

SEC. 3. HOSPICE PROGRAM INTEGRITY.

    (a) Medical Review for Certain Hospice Programs.--Section 1814(i) 
of the Social Security Act (42 U.S.C. 1395f(i)) is amended by adding at 
the end the following new paragraph:
                    ``(8) Medical review for certain hospice 
                programs.--
                            ``(A) In general.--The Secretary shall 
                        implement a process for the medical review of 
                        hospice care furnished by a hospice program 
                        identified under subparagraph (B).
                            ``(B) Identification of hospice programs 
                        for medical review.--The Secretary shall 
                        identify hospice programs the patients of which 
                        will be subject to medical review under 
                        subparagraph (A). In identifying such programs, 
                        the Secretary shall consider multiple factors 
                        in comparison with other similarly situated 
                        hospice programs, such as--
                                    ``(i) the percentage of patients 
                                who were discharged after receiving 
                                hospice care for a period of 120 to 180 
                                days and who were alive upon such 
                                discharge;
                                    ``(ii) the percentage of patients 
                                who are receiving hospice care from the 
                                program at the end of life who receive 
                                no skilled hospice care visits in the 
                                last week of life; and
                                    ``(iii) the level of per-patient 
                                expenditures under this title for 
                                patients of the hospice program 
                                excluding expenditures for hospice 
                                care.
                            ``(C) Limitation on liability of 
                        beneficiary where medicare claims are 
                        disallowed.--The provisions of this title 
                        relating to the limitation on liability of a 
                        beneficiary where Medicare claims are 
                        disallowed shall apply with respect to this 
                        paragraph in the same manner as they apply to 
                        subsection (a)(7)(E).''.
    (b) Developing Interventions To Reduce Hospital Admissions.--The 
Secretary shall develop and publish guidance, where appropriate and in 
consultation with interested parties, for hospice programs to develop 
interventions to reduce hospital admissions and visits to hospital 
emergency departments by patients of such hospice programs.
    (c) Expanding Who May Perform Pre-Hospice Evaluation and Counseling 
Services.--
            (1) In general.--Section 1812(a)(5) of the Social Security 
        Act (42 U.S.C. 1395d(a)(5)) is amended by inserting after 
        ``hospice program'' the following: ``, or services that are 
        furnished by a registered nurse who is an employee of a hospice 
        program in consultation, if necessary, with other members of 
        the interdisciplinary group described in section 
        1861(dd)(2)(B),''.
            (2) Evaluation and report.--
                    (A) Evaluation.--The Secretary shall evaluate the 
                impact of the amendment made by paragraph (1). Such 
                evaluation shall include an evaluation of the impact of 
                such amendment on hospital admission rates, hospice 
                care utilization, and length of stay in hospice 
                programs for patients receiving services under section 
                1812(a)(5) of the Social Security Act (42 U.S.C. 
                1395d(a)(5)).
                    (B) Report.--The Secretary shall submit a report to 
                Congress containing the results of the evaluation under 
                subparagraph (A).
    (d) Expanding Hospice Care Access for Residents Using Skilled 
Nursing Facilities.--
            (1) Medicare and skilled nursing facilities.--Section 1819 
        of the Social Security Act (42 U.S.C. 1395i-3) is amended--
                    (A) in subsection (b)(4), by adding at the end the 
                following new subparagraph:
                    ``(D) Hospice program contracting.--In the case of 
                a facility that contracts with a hospice program for 
                hospice care for its residents, such facility shall 
                make a good faith effort to enter into a contract with 
                more than one hospice program participating under this 
                title that provides services in the area served by the 
                facility, if more than one hospice program is available 
                to serve such residents.''; and
                    (B) in subsection (c)(1)(A)(i), by inserting after 
                ``well-being,'' the following: ``to be fully informed, 
                in a form and manner specified by the Secretary, of any 
                financial interest, as specified by the Secretary, the 
                skilled nursing facility has in any hospice program to 
                which a resident is referred,''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to skilled nursing facilities in operation 1 year 
        after the date of the enactment of this Act.
    (e) Hospital Discharge Planning Provisions Relating to Hospice 
Care.--
            (1) In general.--Section 1861(ee)(2) of the Social Security 
        Act (42 U.S.C. 1395x(ee)(2)) is amended--
                    (A) in subparagraph (D), by striking the period at 
                the end and inserting ``and, in the case of individuals 
                likely to need hospice care, the availability of such 
                care through hospice programs that participate in the 
                program under this title and that serve the area in 
                which the patient resides and that request to be listed 
                by the hospital as available.''; and
                    (B) in subparagraph (H)(i), by inserting ``or 
                hospice care'' after ``home health services''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to discharges occurring on or after 90 days after 
        the date of the enactment of this Act.