I 

114TH CONGRESS 

1ST SESSION H. R. 3037 

To amend title XVIII of the Social Security Act to improve access to hospice 

care under the Medicare program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 13, 2015 

Mr. REED (for himself and Mr. THOMPSON of California) introduced the 

following bill; which was referred to the Committee on Ways and Means 

A BILL 

To amend title XVIII of the Social Security Act to improve 

access to hospice care under the Medicare program, and 

for other purposes. 

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 cited as the ‘‘Hospice Care Access Im5 provement Act of 2015’’. 

6 SEC. 2. HOSPICE PAYMENT REFORM DEMONSTRATION 

7 PROGRAM. 

8 (a) IN GENERAL.—The Secretary of Health and 

9 Human Services (in this Act referred to as the ‘‘Sec10 retary’’) shall conduct a demonstration program for a 1- 


rfrederick on DSK6VPTVN1PROD with BILLS
2 

•HR 3037 IH

1 year period during fiscal year 2016 to test the proposed 

2 hospice payment methodology revisions. 

3 (b) PROPOSED HOSPICE PAYMENT METHODOLOGY

4 REVISIONS DEFINED.—In this section, the term ‘‘pro5 posed hospice payment methodology revisions’’ means re6 visions to the methodology for determining hospice pay7 ment rates under section 1814(i)(6)(D) of the Social Secu8 rity Act (42 U.S.C. 1395f(i)(6)(D)) contained in the Fis9 cal Year 2016 Hospice Wage Index and Payment Rate 

10 Update and Hospice Quality Reporting Requirements as 

11 published by the Centers for Medicare & Medicaid Services 

12 on May 5, 2015 (80 Fed. Reg. 25831 et seq.). 

13 (c) SCOPE.—The Secretary shall select one Medicare 

14 administrative contractor to conduct the demonstration 

15 program. Such contractor shall conduct the demonstration 

16 program with respect to all hospice programs under that 

17 contractor’s jurisdiction. 

18 (d) EVALUATION.—The Secretary shall conduct an 

19 evaluation of the demonstration program, which shall in20 clude an analysis of the impact of the proposed hospice 

21 payment methodology revisions— 

22 (1) on the quality of patient care and the ability 

23 of hospice programs to provide such care; and 

24 (2) on access to hospice care for beneficiaries. 


rfrederick on DSK6VPTVN1PROD with BILLS
3 

•HR 3037 IH

1 (e) REPORT.—Not later than March 31, 2017, the 

2 Secretary shall submit to Congress a report on the dem3 onstration program. The report shall include— 

4 (1) the results of the evaluation under sub5 section (d); and 

6 (2) recommendations for such legislation and 

7 administrative action as the Secretary determines 

8 appropriate. 

9 (f) IMPLEMENTATION OF HOSPICE PAYMENT METH10 ODOLOGY REVISIONS.— 

11 (1) PROHIBITION ON IMPLEMENTATION OF RE12 VISIONS FOR FISCAL YEARS 2016 AND 2017.—No revi13 sions to the hospice payment methodology shall be 

14 made under section 1814(i)(6)(D) of the Social Se15 curity Act (42 U.S.C. 1395f(i)(6)(D)) for fiscal 

16 years 2016 and 2017, except for purposes of the 

17 demonstration program required to be conducted 

18 under subsection (a). 

19 (2) IMPLEMENTATION OF REVISIONS FOR FIS20 CAL YEAR 2018.—After taking into account the re21 sults of the evaluation of the demonstration program 

22 and after making any necessary revisions, the Sec23 retary shall implement the proposed hospice pay24 ment methodology revisions beginning with fiscal 

25 year 2018. 


rfrederick on DSK6VPTVN1PROD with BILLS
4 

•HR 3037 IH

1 SEC. 3. HOSPICE PROGRAM INTEGRITY. 

2 (a) MEDICAL REVIEW FOR CERTAIN HOSPICE PRO3 GRAMS.—Section 1814(i) of the Social Security Act (42 

4 U.S.C. 1395f(i)) is amended by adding at the end the fol5 lowing new paragraph: 

6 ‘‘(8) MEDICAL REVIEW FOR CERTAIN HOS7 PICE PROGRAMS.— 

8 ‘‘(A) IN GENERAL.—The Secretary 

9 shall implement a process for the medical 

10 review of hospice care furnished by a hos11 pice program identified under subpara12 graph (B). 

13 ‘‘(B) IDENTIFICATION OF HOSPICE

14 PROGRAMS FOR MEDICAL REVIEW.—The 

15 Secretary shall identify hospice programs 

16 the patients of which will be subject to 

17 medical review under subparagraph (A). In 

18 identifying such programs, the Secretary 

19 shall consider multiple factors in compari20 son with other similarly situated hospice 

21 programs, such as— 

22 ‘‘(i) the percentage of patients 

23 who were discharged after receiving 

24 hospice care for a period of 120 to 

25 180 days and who were alive upon 

26 such discharge; 


rfrederick on DSK6VPTVN1PROD with BILLS
5 

•HR 3037 IH

1 ‘‘(ii) the percentage of patients 

2 who are receiving hospice care from 

3 the program at the end of life who re4 ceive no skilled hospice care visits in 

5 the last week of life; and 

6 ‘‘(iii) the level of per-patient ex7 penditures under this title for patients 

8 of the hospice program excluding ex9 penditures for hospice care. 

10 ‘‘(C) LIMITATION ON LIABILITY OF

11 BENEFICIARY WHERE MEDICARE CLAIMS

12 ARE DISALLOWED.—The provisions of this 

13 title relating to the limitation on liability of 

14 a beneficiary where Medicare claims are 

15 disallowed shall apply with respect to this 

16 paragraph in the same manner as they 

17 apply to subsection (a)(7)(E).’’. 

18 (b) DEVELOPING INTERVENTIONS TO REDUCE HOS19 PITAL ADMISSIONS.—The Secretary shall develop and 

20 publish guidance, where appropriate and in consultation 

21 with interested parties, for hospice programs to develop 

22 interventions to reduce hospital admissions and visits to 

23 hospital emergency departments by patients of such hos24 pice programs. 


rfrederick on DSK6VPTVN1PROD with BILLS
6 

•HR 3037 IH

1 (c) EXPANDING WHO MAY PERFORM PRE-HOSPICE

2 EVALUATION AND COUNSELING SERVICES.— 

3 (1) IN GENERAL.—Section 1812(a)(5) of the 

4 Social Security Act (42 U.S.C. 1395d(a)(5)) is 

5 amended by inserting after ‘‘hospice program’’ the 

6 following: ‘‘, or services that are furnished by a reg7 istered nurse who is an employee of a hospice pro8 gram in consultation, if necessary, with other mem9 bers of the interdisciplinary group described in sec10 tion 1861(dd)(2)(B),’’. 

11 (2) EVALUATION AND REPORT.— 

12 (A) EVALUATION.—The Secretary shall 

13 evaluate the impact of the amendment made by 

14 paragraph (1). Such evaluation shall include an 

15 evaluation of the impact of such amendment on 

16 hospital admission rates, hospice care utiliza17 tion, and length of stay in hospice programs for 

18 patients receiving services under section 

19 1812(a)(5) of the Social Security Act (42 

20 U.S.C. 1395d(a)(5)). 

21 (B) REPORT.—The Secretary shall submit 

22 a report to Congress containing the results of 

23 the evaluation under subparagraph (A). 

24 (d) EXPANDING HOSPICE CARE ACCESS FOR RESI25 DENTS USING SKILLED NURSING FACILITIES.— 


rfrederick on DSK6VPTVN1PROD with BILLS
7 

•HR 3037 IH

1 (1) MEDICARE AND SKILLED NURSING FACILI2 TIES.—Section 1819 of the Social Security Act (42 

3 U.S.C. 1395i–3) is amended— 

4 (A) in subsection (b)(4), by adding at the 

5 end the following new subparagraph: 

6 ‘‘(D) HOSPICE PROGRAM CONTRACTING.— 

7 In the case of a facility that contracts with a 

8 hospice program for hospice care for its resi9 dents, such facility shall make a good faith ef10 fort to enter into a contract with more than one 

11 hospice program participating under this title 

12 that provides services in the area served by the 

13 facility, if more than one hospice program is 

14 available to serve such residents.’’; and 

15 (B) in subsection (c)(1)(A)(i), by inserting 

16 after ‘‘well-being,’’ the following: ‘‘to be fully in17 formed, in a form and manner specified by the 

18 Secretary, of any financial interest, as specified 

19 by the Secretary, the skilled nursing facility has 

20 in any hospice program to which a resident is 

21 referred,’’. 

22 (2) EFFECTIVE DATE.—The amendments made 

23 by this subsection shall apply to skilled nursing fa24 cilities in operation 1 year after the date of the en25 actment of this Act. 


rfrederick on DSK6VPTVN1PROD with BILLS
8 

•HR 3037 IH

1 (e) HOSPITAL DISCHARGE PLANNING PROVISIONS

2 RELATING TO HOSPICE CARE.— 

3 (1) IN GENERAL.—Section 1861(ee)(2) of the 

4 Social Security Act (42 U.S.C. 1395x(ee)(2)) is 

5 amended— 

6 (A) in subparagraph (D), by striking the 

7 period at the end and inserting ‘‘and, in the 

8 case of individuals likely to need hospice care, 

9 the availability of such care through hospice 

10 programs that participate in the program under 

11 this title and that serve the area in which the 

12 patient resides and that request to be listed by 

13 the hospital as available.’’; and 

14 (B) in subparagraph (H)(i), by inserting 

15 ‘‘or hospice care’’ after ‘‘home health services’’. 

16 (2) EFFECTIVE DATE.—The amendments made 

17 by this subsection shall apply to discharges occur18 ring on or after 90 days after the date of the enact19 ment of this Act. 

Æ 


rfrederick on DSK6VPTVN1PROD with BILLS