I 

112TH CONGRESS 

1ST SESSION H. R. 3506 

To strengthen and protect Medicare hospice programs. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 22, 2011 

Mr. REED (for himself, Mr. PAULSEN, and Mr. THOMPSON of California) 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 strengthen and protect Medicare hospice programs. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Hospice Evaluation 

5 and Legitimate Payment Act’’. 

6 SEC. 2. ENSURING TIMELY ACCESS TO HOSPICE CARE. 

7 (a) IN GENERAL.—Section 1814(a)(7)(D)(i) of the 

8 Social Security Act (42 U.S.C. 1395f(a)(7)(D)(i)) is 

9 amended to read as follows: 

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1 ‘‘(i) a hospice physician, a nurse prac2 titioner, a clinical nurse specialist, or a 

3 physician assistant (as those terms are de4 fined in section 1861(aa)(5)), or other 

5 health professional (as designated by the 

6 Secretary), has a face-to-face encounter 

7 with the individual to determine continued 

8 eligibility of the individual for hospice care 

9 prior to the first 60-day period and each 

10 subsequent recertification under subpara11 graph (A)(ii) (or, in the case where a hos12 pice program newly admits an individual 

13 who would be entering their first 60-day 

14 period or a subsequent hospice benefit pe15 riod or where exceptional circumstances, as 

16 defined by the Secretary, may prevent a 

17 face-to-face encounter prior to the begin18 ning of the hospice benefit period, not later 

19 than 7 calendar days after the individual’s 

20 election under section 1812(d)(1) with re21 spect to the hospice program) and attests 

22 that such visit took place (in accordance 

23 with procedures established by the Sec24 retary); and’’. 

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1 (b) EFFECTIVE DATE.—The amendment made by 

2 subsection (a) takes effect on the date of enactment of 

3 this Act and applies to hospice care furnished on or after 

4 such date. 

5 SEC. 3. RESTORING AND PROTECTING THE MEDICARE HOS6 PICE BENEFIT. 

7 (a) IN GENERAL.—Section 1814(i) of the Social Se8 curity Act (42 U.S.C. 1395f(i)) is amended— 

9 (1) in subparagraph (1)(C)— 

10 (A) in clause (ii)— 

11 (i) in the matter preceding subclause 

12 (I), by striking ‘‘(6)(D)’’ and inserting 

13 ‘‘(6)(E)’’; and 

14 (ii) in subclause (VII), by striking 

15 ‘‘(6)(D)’’ and inserting ‘‘(6)(E)’’; and 

16 (B) in clause (iii), by moving such clause 

17 6 ems to the left and striking ‘‘(6)(D)’’ and in18 serting ‘‘(6)(E)’’; and 

19 (2) in paragraph (6)— 

20 (A) in subparagraph (A), by striking ‘‘sub21 paragraph (D)’’ and inserting ‘‘subparagraph 

22 (E)’’; 

23 (B) by redesignating subparagraphs (D) 

24 and (E) as subparagraphs (E) and (F), respecmstockstill on DSK4VPTVN1PROD with BILLS

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1 tively, and inserting after subparagraph (C) the 

2 following new subparagraph: 

3 ‘‘(D) HOSPICE PAYMENT REFORM DEMONSTRA4 TION PROGRAM.— 

5 ‘‘(i) ESTABLISHMENT OF DEMONSTRATION

6 PROGRAM.— 

7 ‘‘(I) IN GENERAL.—Prior to imple8 menting any revisions to the methodology 

9 for determining the payment rates for rou10 tine home care and other services included 

11 in hospice care under subparagraph (E), 

12 the Secretary shall establish a Medicare 

13 Hospice Payment Reform demonstration 

14 program to test such proposed revisions. 

15 ‘‘(II) DURATION.—The demonstration 

16 program shall be conducted for a 2-year 

17 period beginning on or after October 1, 

18 2013. 

19 ‘‘(III) SCOPE.—The Secretary shall 

20 select not more than 15 hospice programs 

21 at which the demonstration program under 

22 this subparagraph shall be conducted. 

23 ‘‘(IV) REPRESENTATIVE PARTICIPA24 TION.—Hospice programs selected under 

25 subclause (III) to participate in the demmstockstill on DSK4VPTVN1PROD with BILLS

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1 onstration program shall include a rep2 resentative cross-section of such programs 

3 throughout the United States, including 

4 programs located in urban and rural areas. 

5 ‘‘(V) VOLUNTARY PARTICIPATION.— 

6 Hospice program participation in the dem7 onstration program shall be on a voluntary 

8 basis. 

9 ‘‘(ii) EVALUATION AND REPORT.— 

10 ‘‘(I) EVALUATION.—The Secretary 

11 shall conduct an evaluation of the dem12 onstration program under this subpara13 graph. Such evaluation shall include an 

14 analysis of whether the use of the revised 

15 payment methodology under the dem16 onstration program has improved the qual17 ity of patient care and access to hospice 

18 services for beneficiaries under this title 

19 and the impact of such payment revisions 

20 on hospice care providers, including the 

21 impact, if any, on the ability of hospice 

22 programs to furnish quality care to bene23 ficiaries under this title. 

24 ‘‘(II) REPORT.—Not later than 1 year 

25 after the completion of the demonstration 

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1 program, the Secretary shall submit to 

2 Congress a report containing the results of 

3 the evaluation conducted under subclause 

4 (I), together with recommendations for 

5 such legislation and administrative action 

6 as the Secretary determines appropriate. 

7 ‘‘(iii) BUDGET NEUTRALITY.—With respect 

8 to the 2-year period of the demonstration pro9 gram under this subparagraph, the Secretary 

10 shall ensure that the estimated amount of ag11 gregate payments under this title to each hos12 pice program participating in the demonstration 

13 program for such period shall not be more than 

14 5 percent higher or 5 percent lower than the es15 timated amount of aggregate payments that 

16 would have been made under this title to each 

17 such hospice program during such period had 

18 they not participated in the demonstration pro19 gram under this subparagraph.’’; 

20 (C) in subparagraph (E), as redesignated 

21 by subparagraph (B)— 

22 (i) in clause (i)— 

23 (I) in the first sentence, by strik24 ing ‘‘October 1, 2013, the Secretary 

25 shall, by regulation’’ and inserting 

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1 ‘‘subject to clause (iii), the later of 2 

2 years after the demonstration pro3 gram under subparagraph (D) is com4 pleted or October 1, 2017, the Sec5 retary shall, by regulation, preceded 

6 by notice of the proposed regulation in 

7 the Federal Register and a period for 

8 public comment in accordance with 

9 section 1871(b)(1),’’; and 

10 (II) in the second sentence, by 

11 inserting ‘‘, and shall take into ac12 count the results of the evaluation 

13 conducted under subparagraph 

14 (D)(ii)’’ before the period; and 

15 (ii) by adding at the end the following 

16 new clause: 

17 ‘‘(iii) In no case may the Secretary imple18 ment any revisions in payment pursuant to 

19 clause (i) unless the Secretary determines that 

20 the demonstration program under subparagraph 

21 (D) demonstrated that such revisions would not 

22 adversely affect access to quality hospice care 

23 by beneficiaries under this title.’’; and 

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1 (D) in subparagraph (F), as redesignated 

2 by subparagraph (B), by striking ‘‘subpara3 graph (D)’’ and inserting ‘‘subparagraph (E)’’. 

4 SEC. 4. HOSPICE SURVEY REQUIREMENT. 

5 (a) IN GENERAL.—Section 1861(dd)(4) of the Social 

6 Security Act (42 U.S.C. 1395x(dd)(4)) is amended by 

7 adding at the end the following new subparagraph: 

8 ‘‘(C) Any entity seeking certification as a hospice pro9 gram shall be subject to an initial survey by an appro10 priate State or local survey agency, or an approved accred11 itation agency, as determined by the Secretary, not later 

12 than 6 months after beginning operations, and any entity 

13 which is certified as a hospice program shall be subject 

14 to a standard survey not less frequently than every 36 

15 months.’’. 

16 (b) EFFECTIVE DATE.—The amendment made by 

17 subsection (a) takes effect on the date that is 180 days 

18 after the date of enactment of this Act and applies to hos19 pice programs on or after such date. 

Æ 

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