II 

113TH CONGRESS 

1ST SESSION S. 1053 

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

Medicare hospice programs. 

IN THE SENATE OF THE UNITED STATES 

MAY 23, 2013 

Mr. WYDEN (for himself and Mr. ROBERTS) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

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’’. 

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, nurse practi2 tioner, clinical nurse specialist, or physi3 cian assistant (as those terms are defined 

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

5 professional (as designated by the Sec6 retary), has a face-to-face encounter with 

7 the individual to determine continued eligi8 bility 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 January 1, 2014, and ap3 plies to hospice care furnished on or after such date. 

4 SEC. 3. RESTORING AND PROTECTING THE MEDICARE HOS5 PICE BENEFIT. 

6 (a) IN GENERAL.—Section 1814(i) of the Social Se7 curity Act (42 U.S.C. 1395f(i)) is amended— 

8 (1) in paragraph (6)— 

9 (A) in subparagraph (D)— 

10 (i) in clause (i)— 

11 (I) in the first sentence, by strik12 ing ‘‘not earlier than October 1, 2013, 

13 the Secretary shall, by regulation,’’ 

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

15 not earlier than the later of 2 years 

16 after the demonstration program 

17 under subparagraph (F) is completed 

18 or October 1, 2017, the Secretary 

19 shall, by regulation, preceded by a no20 tice of the proposed regulation in the 

21 Federal Register and a period for 

22 public comment in accordance with 

23 section 1871(b)(1),’’; and 

24 (II) in the second sentence, by 

25 inserting ‘‘ and shall take into acVerDate Mar 15 2010 20:42 May 29, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1053.IS S1053

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1 count the results of the evaluation 

2 conducted under subparagraph 

3 (F)(ii)’’ before the period; and 

4 (ii) by adding at the end the following 

5 new clause: 

6 ‘‘(iii) The Secretary shall implement the 

7 revisions in payment pursuant to clause (i) un8 less the Secretary determines that the dem9 onstration program under subparagraph (F) 

10 demonstrated that such revisions would ad11 versely affect access to quality hospice care by 

12 beneficiaries under this title.’’; and 

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

14 subparagraph: 

15 ‘‘(F) HOSPICE PAYMENT REFORM DEMONSTRA16 TION PROGRAM.— 

17 ‘‘(i) ESTABLISHMENT OF DEMONSTRATION

18 PROGRAM.— 

19 ‘‘(I) IN GENERAL.—Before imple20 menting any revisions to the methodology 

21 for determining the payment rates for rou22 tine home care and other services included 

23 in hospice care under subparagraph (D), 

24 the Secretary shall establish a Medicare 

25 Hospice Payment Reform demonstration 


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1 program (in this subparagraph referred to 

2 as the ‘demonstration program’) to test 

3 such proposed revisions. 

4 ‘‘(II) DURATION.—The demonstration 

5 program shall be conducted for a 2-year 

6 period beginning on or after October 1, 

7 2013. 

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

9 program may apply to participate in the 

10 demonstration program and the Secretary 

11 shall select not more than 15 such hospice 

12 programs to participate in the demonstra13 tion program. 

14 ‘‘(IV) REPRESENTATIVE PARTICIPA15 TION.—Hospice programs selected under 

16 subclause (III) to participate in the dem17 onstration program shall include a rep18 resentative cross-section of hospice pro19 grams throughout the United States, in20 cluding programs located in urban and 

21 rural areas. 

22 ‘‘(ii) EVALUATION AND REPORT.— 

23 ‘‘(I) EVALUATION.—The Secretary 

24 shall conduct an evaluation of the dem25 onstration program. Such evaluation shall 


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1 include an analysis of whether the use of 

2 the revised payment methodology under 

3 the demonstration program has improved 

4 the quality of patient care and access to 

5 hospice care for beneficiaries under this 

6 title and the impact of such payment revi7 sions on hospice care providers, including 

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

9 programs to furnish quality care to bene10 ficiaries under this title. 

11 ‘‘(II) REPORT.—Not later than 2 

12 years after the completion of the dem13 onstration program, the Secretary shall 

14 submit to Congress a report containing the 

15 results of the evaluation conducted under 

16 subclause (I), together with recommenda17 tions for such legislation and administra18 tive action as the Secretary determines ap19 propriate. 

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

21 to the 2-year period of the demonstration pro22 gram, the Secretary shall ensure that revisions 

23 in payment implemented as part of the dem24 onstration program shall result in the same es25 timated amount of aggregate payments under 


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1 this title for hospice care for the programs par2 ticipating in the demonstration as would have 

3 been made if the hospice programs had not par4 ticipated in the demonstration program.’’. 

5 SEC. 4. HOSPICE SURVEY REQUIREMENT. 

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

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

8 the following new subparagraph: 

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

10 shall be subject to a standard survey by an appropriate 

11 State or local survey agency, or an approved accreditation 

12 agency, as determined by the Secretary, not less fre13 quently than once every 36 months beginning 6 months 

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

Æ 


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