I 

113TH CONGRESS 

1ST SESSION H. R. 2302 

To amend title XVIII of the Social Security Act to strengthen and protect 

Medicare hospice programs. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 6, 2013 

Mr. REED (for himself, Mr. THOMPSON of California, Mr. PAULSEN, Mr. 

BLUMENAUER, Mr. MICHAUD, Mr. CONNOLLY, Mr. YOUNG of Florida, 

Mr. KING of Iowa, and Mr. GRIJALVA) 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 amend title XVIII of the Social Security Act 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 of 2013’’. 

mstockstill on DSK4VPTVN1PROD with BILLS

2 

•HR 2302 IH

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

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

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

4 amended to read as follows: 

5 ‘‘(i) a hospice physician, nurse practi6 tioner, clinical nurse specialist, or physi7 cian assistant (as those terms are defined 

8 in section 1861(aa)(5)), or other health 

9 professional (as designated by the Sec10 retary), has a face-to-face encounter with 

11 the individual to determine continued eligi12 bility of the individual for hospice care 

13 prior to the first 60-day period and each 

14 subsequent recertification under subpara15 graph (A)(ii) (or, in the case where a hos16 pice program newly admits an individual 

17 who would be entering their first 60-day 

18 period or a subsequent hospice benefit pe19 riod or where exceptional circumstances, as 

20 defined by the Secretary, may prevent a 

21 face-to-face encounter prior to the begin22 ning of the hospice benefit period, not later 

23 than 7 calendar days after the individual’s 

24 election under section 1812(d)(1) with re25 spect to the hospice program) and attests 

26 that such visit took place (in accordance 

mstockstill on DSK4VPTVN1PROD with BILLS

3 

•HR 2302 IH

1 with procedures established by the Sec2 retary); and’’. 

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

4 subsection (a) takes effect on January 1, 2014, and ap5 plies to hospice care furnished on or after such date. 

6 SEC. 3. RESTORING AND PROTECTING THE MEDICARE HOS7 PICE BENEFIT. 

8 (a) IN GENERAL.—Section 1814(i) of the Social Se9 curity Act (42 U.S.C. 1395f(i)) is amended— 

10 (1) in paragraph (6)— 

11 (A) in subparagraph (D)— 

12 (i) in clause (i)— 

13 (I) in the first sentence, by strik14 ing ‘‘not earlier than October 1, 2013, 

15 the Secretary shall, by regulation,’’ 

16 and inserting ‘‘subject to clause (iii), 

17 not earlier than the later of 2 years 

18 after the demonstration program 

19 under subparagraph (F) is completed 

20 or October 1, 2017, the Secretary 

21 shall, by regulation, preceded by a no22 tice of the proposed regulation in the 

23 Federal Register and a period for 

24 public comment in accordance with 

25 section 1871(b)(1),’’; and 

mstockstill on DSK4VPTVN1PROD with BILLS

4 

•HR 2302 IH

1 (II) in the second sentence, by 

2 inserting ‘‘ and shall take into ac3 count the results of the evaluation 

4 conducted under subparagraph 

5 (F)(ii)’’ before the period; and 

6 (ii) by adding at the end the following 

7 new clause: 

8 ‘‘(iii) The Secretary shall implement the 

9 revisions in payment pursuant to clause (i) un10 less the Secretary determines that the dem11 onstration program under subparagraph (F) 

12 demonstrated that such revisions would ad13 versely affect access to quality hospice care by 

14 beneficiaries under this title.’’; and 

15 (B) by adding at the end the following new 

16 subparagraph: 

17 ‘‘(F) HOSPICE PAYMENT REFORM DEMONSTRA18 TION PROGRAM.— 

19 ‘‘(i) ESTABLISHMENT OF DEMONSTRATION

20 PROGRAM.— 

21 ‘‘(I) IN GENERAL.—Before imple22 menting any revisions to the methodology 

23 for determining the payment rates for rou24 tine home care and other services included 

25 in hospice care under subparagraph (D), 

mstockstill on DSK4VPTVN1PROD with BILLS

5 

•HR 2302 IH

1 the Secretary shall establish a Medicare 

2 Hospice Payment Reform demonstration 

3 program (in this subparagraph referred to 

4 as the ‘demonstration program’) to test 

5 such proposed revisions. 

6 ‘‘(II) DURATION.—The demonstration 

7 program shall be conducted for a 2-year 

8 period beginning on or after October 1, 

9 2013. 

10 ‘‘(III) SCOPE.—Any certified hospice 

11 program may apply to participate in the 

12 demonstration program and the Secretary 

13 shall select not more than 15 such hospice 

14 programs to participate in the demonstra15 tion program. 

16 ‘‘(IV) REPRESENTATIVE PARTICIPA17 TION.—Hospice programs selected under 

18 subclause (III) to participate in the dem19 onstration program shall include a rep20 resentative cross-section of hospice pro21 grams throughout the United States, in22 cluding programs located in urban and 

23 rural areas. 

24 ‘‘(ii) EVALUATION AND REPORT.— 

mstockstill on DSK4VPTVN1PROD with BILLS

6 

•HR 2302 IH

1 ‘‘(I) EVALUATION.—The Secretary 

2 shall conduct an evaluation of the dem3 onstration program. Such evaluation shall 

4 include an analysis of whether the use of 

5 the revised payment methodology under 

6 the demonstration program has improved 

7 the quality of patient care and access to 

8 hospice care for beneficiaries under this 

9 title and the impact of such payment revi10 sions on hospice care providers, including 

11 the impact, if any, on the ability of hospice 

12 programs to furnish quality care to bene13 ficiaries under this title. 

14 ‘‘(II) REPORT.—Not later than 2 

15 years after the completion of the dem16 onstration program, the Secretary shall 

17 submit to Congress a report containing the 

18 results of the evaluation conducted under 

19 subclause (I), together with recommenda20 tions for such legislation and administra21 tive action as the Secretary determines ap22 propriate. 

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

24 to the 2-year period of the demonstration pro25 gram, the Secretary shall ensure that revisions 

mstockstill on DSK4VPTVN1PROD with BILLS

7 

•HR 2302 IH

1 in payment implemented as part of the dem2 onstration program shall result in the same es3 timated amount of aggregate payments under 

4 this title for hospice care for the programs par5 ticipating in the demonstration as would have 

6 been made if the hospice programs had not par7 ticipated in the demonstration program.’’. 

8 SEC. 4. HOSPICE SURVEY REQUIREMENT. 

9 Section 1861(dd)(4) of the Social Security Act (42 

10 U.S.C. 1395x(dd)(4)) is amended by adding at the end 

11 the following new subparagraph: 

12 ‘‘(C) Any entity that is certified as a hospice program 

13 shall be subject to a standard survey by an appropriate 

14 State or local survey agency, or an approved accreditation 

15 agency, as determined by the Secretary, not less fre16 quently than once every 36 months beginning 6 months 

17 after the date of the enactment of this subparagraph.’’. 

Æ 

mstockstill on DSK4VPTVN1PROD with BILLS