II

104TH CONGRESS

2D SESSION S. 2034

To amend title XVIII of the Social Security Act to make certain changes

to hospice care under the Medicare program.

IN THE SENATE OF THE UNITED STATES

AUGUST 2, 1996

Mr. BREAUX (for himself, Mr. MACK, Mr. GRAHAM, and Mr. COHEN) 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 make

certain changes to hospice care under the Medicare program.

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 ‘‘Medicare Hospice Ben5 efit Amendments of 1996’’.

6 SEC. 2. HOSPICE CARE BENEFIT PERIODS.

7 (a) RESTRUCTURING OF BENEFIT PERIOD.—Section

8 1812 of the Social Security Act (42 U.S.C. 1395d) is

9 amended in subsections (a)(4) and (d)(1), by striking ‘‘,

10 a subsequent period of 30 days, and a subsequent exten-
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1 sion period’’ and inserting ‘‘and an unlimited number of

2 subsequent periods of 60 days each’’.

3 (b) CONFORMING AMENDMENTS.—(1) Section

4 1812(d)(2)(B) of such Act (42 U.S.C. 1395d(d)(2)(B)) is

5 amended by striking ‘‘90- or 30-day period or a subse6 quent extension period’’ and inserting ‘‘90-day period or

7 a subsequent 60-day period’’.

8 (2) Section 1814(a)(7)(A) of such Act (42 U.S.C.

9 1395f(a)(7)(A)) is amended—

10 (A) in clause (i), by inserting ‘‘and’’ at the end;

11 (B) in clause (ii)—

12 (i) by striking ‘‘30-day’’ and inserting ‘‘60-

13 day’’; and

14 (ii) by striking ‘‘and’’ at the end and in15 serting a period; and

16 (C) by striking clause (iii).

17 SEC. 3. AMBULANCE SERVICES, DIAGNOSTIC TESTS, CHEM18 OTHERAPY SERVICES, AND RADIATION THER19 APY SERVICES INCLUDED IN HOSPICE CARE.

20 Section 1861(dd)(1) of the Social Security Act (42

21 U.S.C. 1395x(dd)(1)) is amended—

22 (1) in subparagraph (E), by inserting

23 ‘‘anticancer chemotherapeutic agents and other’’ be24 fore ‘‘drugs’’;
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1 (2) in subparagraph (G), by striking ‘‘and’’ at

2 the end;

3 (3) in subparagraph (H), by striking the period

4 at the end and inserting a comma; and

5 (4) by inserting after subparagraph (H) the fol6 lowing:

7 ‘‘(I) ambulance services,

8 ‘‘(J) diagnostic tests, and

9 ‘‘(K) radiation therapy services.’’.

10 SEC. 4. CONTRACTING WITH INDEPENDENT PHYSICIANS

11 OR PHYSICIAN GROUPS FOR HOSPICE CARE

12 SERVICES PERMITTED.

13 Section 1861(dd)(2) of the Social Security Act (42

14 U.S.C. 1395x(dd)(2)) is amended—

15 (1) in subparagraph (A)(ii)(I), by striking

16 ‘‘(F),’’; and

17 (2) in subparagraph (B)(i), by inserting ‘‘or

18 under contract with’’ after ‘‘employed by’’.

19 SEC. 5. WAIVER OF CERTAIN STAFFING REQUIREMENTS

20 FOR HOSPICE CARE PROGRAMS IN NON-UR21 BANIZED AREAS.

22 Section 1861(dd)(5) of the Social Security Act (42

23 U.S.C. 1395x(dd)(5)) is amended—

24 (1) in subparagraph (B), by inserting ‘‘or (C)’’

25 after ‘‘subparagraph (A)’’ each place it appears; and
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1 (2) by adding at the end the following:

2 ‘‘(C) The Secretary may waive the requirements of

3 paragraphs (2)(A)(i) and (2)(A)(ii) for an agency or orga4 nization with respect to the services described in para5 graph (1)(B) and, with respect to dietary counseling,

6 paragraph (1)(H), if such agency or organization—

7 ‘‘(i) is located in an area which is not an urban8 ized area (as defined by the Bureau of Census), and

9 ‘‘(ii) demonstrates to the satisfaction of the

10 Secretary that the agency or organization has been

11 unable, despite diligent efforts, to recruit appro12 priate personnel.’’.

13 SEC. 6. LIMITATION ON LIABILITY OF BENEFICIARIES AND

14 PROVIDERS FOR CERTAIN HOSPICE COV15 ERAGE DENIALS.

16 (a) IN GENERAL.—Section 1879(g) of the Social Se17 curity Act (42 U.S.C. 1395pp(g)) is amended—

18 (1) by redesignating paragraphs (1) and (2) as

19 subparagraphs (A) and (B), respectively, and mov20 ing such subparagraphs 2 ems to the right;

21 (2) by striking ‘‘is,’’ and inserting ‘‘is—’’;

22 (3) by making the remaining text of subsection

23 (g), as amended, that follows ‘‘is—’’ a new para24 graph (1) and indenting such paragraph 2 ems to

25 the right;
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1 (4) by striking the period at the end and insert2 ing ‘‘; and’’; and

3 (5) by adding at the end the following new

4 paragraph:

5 ‘‘(2) with respect to the provision of hospice

6 care to an individual, a determination that the indi7 vidual is not terminally ill.’’.

8 (b) WAIVER PERIOD EXTENDED.—Section

9 9305(f)(2) of the Omnibus Budget Reconciliation Act of

10 1986 is amended by striking ‘‘and before December 31,

11 1995.’’.

12 (c) EFFECTIVE DATE.—The amendments made by

13 this section shall take effect on December 31, 1995.

14 SEC. 7. EXTENDING THE PERIOD FOR PHYSICIAN CERTIFI15 CATION OF AN INDIVIDUAL’S TERMINAL ILL16 NESS.

17 Section 1814(a)(7)(A)(i)(II) of the Social Security

18 Act (42 U.S.C. 1395f(a)(7)(A)(i)(II)) is amended by strik19 ing ‘‘, not later than 2 days after hospice care is initiated

20 (or, if each certify verbally not later than 2 days after

21 hospice care is initiated, not later than 8 days after such

22 care is initiated),’’ and inserting ‘‘at the beginning of the

23 period’’.
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1 SEC. 8. EFFECTIVE DATE.

2 Except as provided in section 6(c), the amendments

3 made by this Act shall apply to benefits provided on or

4 after the date of the enactment of this Act, regardless of

5 whether or not an individual has made an election under

6 section 1812(d) of the Social Security Act before such

7 date.

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