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[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 3026 Introduced in Senate (IS)]

106th CONGRESS
  2d Session
                                S. 3026

      To establish a hospice demonstration and grant program for 
   beneficiaries under the Medicare Program under title XVIII of the 
              Social Security Act, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           September 12, 2000

   Mr. Wyden introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
      To establish a hospice demonstration and grant program for 
   beneficiaries under the Medicare Program under title XVIII of the 
              Social Security Act, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Hospice Improvement Program Act of 
2000''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) Each year more than \1/3\ of the people who die suffer 
        from a chronic illness.
            (2) Approximately \1/3\ of Americans are unsure about whom 
        to contact to get the best care during life's last stages.
            (3) Americans want a team of professionals to care for the 
        patient at the end of life.
            (4) Americans want emotional and spiritual support for the 
        patient and family.
            (5) Ninety percent of Americans do not realize that hospice 
        care is a benefit provided under the medicare program under 
        title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.).
            (6) Health Care Financing Administration data show that 
        beneficiaries were enrolled in hospice for an average of less 
        than 7 weeks in 1998, far less than the full 6-month benefit 
        under the medicare program.
            (7) According to the most recent data available, although 
        the average hospice enrollment is longer, half of the enrollees 
        live only 30 days after admission and almost 20 percent die 
        within 1 week of enrollment.
            (8) Use of hospice among medicare beneficiaries has been 
        decreasing, from a high of 59 days in 1995 to less than 48 days 
        in 1998.

SEC. 3. HOSPICE DEMONSTRATION PROGRAM AND HOSPICE EDUCATION GRANTS.

    (a) Definitions.--In this section:
            (1) Demonstration program.--The term ``demonstration 
        program'' means the Hospice Demonstration Program established 
        by the Secretary under subsection (b)(1).
            (2) Medicare beneficiary.--The term ``medicare 
        beneficiary'' means any individual who is entitled to benefits 
        under part A or enrolled under part B of the medicare program, 
        including any individual enrolled in a Medicare+Choice plan 
        offered by a Medicare+Choice organization under part C of such 
        program.
            (3) Medicare hospice services.--The term ``medicare hospice 
        services'' means the items and services for which payment may 
        be made under section 1814(i) of the Social Security Act (42 
        U.S.C. 1395f(i)).
            (4) Medicare program.--The term ``medicare program'' means 
        the health benefits program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services, acting through the Administrator 
        of the Health Care Financing Administration.
    (b) Hospice Demonstration Program.--
            (1) Establishment.--The Secretary shall establish a Hospice 
        Demonstration Program in accordance with the provisions of this 
        subsection to increase the utility of the medicare hospice 
        services for medicare beneficiaries.
            (2) Services under demonstration program.--The provisions 
        of section 1814(i) of the Social Security Act (42 U.S.C. 
        1395f(i)) shall apply to the payment for items and services 
        provided under the demonstration program, except that--
                    (A) notwithstanding section 1862(a)(1)(C) of such 
                Act (42 U.S.C. 1395y(a)(1)(C)), the Secretary shall 
                provide for reimbursement for items and services 
                provided under the supportive and comfort care benefit 
                established under paragraph (3);
                    (B) any licensed nurse practitioner or physician 
                assistant may certify a medicare beneficiary as the 
                primary care provider when necessary and within the 
                scope of practice of such practitioner or assistant 
                under State law;
                    (C) if a community does not have a qualified social 
                worker, any professional who has the necessary 
                knowledge, skills, and ability (other than social 
                workers) to provide medical social services shall 
                provide such services;
                    (D) the Secretary shall waive any requirement that 
                nursing facilities used for respite care have skilled 
                nurses on the premises 24 hours per day;
                    (E) the Secretary shall permit respite care to be 
                provided to the medicare beneficiary at home; and
                    (F) the Secretary shall waive reimbursement 
                regulations to provide--
                            (i) reimbursement for consultations and 
                        preadmission informational visits, even if the 
                        medicare beneficiary does not choose hospice 
                        care (including the supportive and comfort care 
                        benefit under paragraph (3)) at that time;
                            (ii) a minimum payment for medicare hospice 
                        services provided under the demonstration 
                        program based on the provision of medicare 
                        hospice services to a medicare beneficiary for 
                        a period of 14 days, that the Secretary shall 
pay to any hospice provider participating in the demonstration program 
and providing such services (regardless of the length of stay of the 
medicare beneficiary);
                            (iii) an increase in the reimbursement 
                        rates for hospice services to offset--
                                    (I) changes in medicare hospice 
                                services and oversight under the 
                                demonstration program;
                                    (II) the higher costs of providing 
                                medicare hospice services in rural 
                                areas due to lack of economies of scale 
                                or large geographic areas; and
                                    (III) the higher costs of providing 
                                medicare hospice services in urban 
                                underserved areas due to unique costs 
                                specifically associated with people 
                                living in those areas, including 
                                providing security;
                            (iv) direct payment of any nurse 
                        practitioner or physician assistant practicing 
                        within the scope of State law in relation to 
                        medicare hospice services provided by such 
                        practitioner or assistant; and
                            (v) a per diem rate of payment for in-home 
                        care under subparagraph (E) that reflects the 
                        range of care needs of the medicare beneficiary 
                        and that--
                                    (I) in the case of a medicare 
                                beneficiary that needs routine care, is 
                                not less than 150 percent, and not more 
                                than 200 percent, of the routine home 
                                care rate for medicare hospice 
                                services; and
                                    (II) in the case of a medicare 
                                beneficiary that needs acute care, is 
                                equal to the continuous home care day 
                                rate for medicare hospice services.
            (3) Supportive and comfort care benefit.--
                    (A) In general.--For purposes of the demonstration 
                program, the Secretary shall establish a supportive and 
                comfort care benefit for any eligible medicare 
                beneficiary (as defined in subparagraph (C)).
                    (B) Benefit.--Under the supportive and comfort care 
                benefit established under subparagraph (A), any 
                eligible medicare beneficiary may--
                            (i) continue to receive benefits for 
                        disease and symptom modifying treatment under 
                        the medicare program (and the Secretary may not 
                        require or prohibit any specific treatment or 
                        decision);
                            (ii) receive case management and medicare 
                        hospice services through a hospice provider, 
                        which the Secretary shall reimburse on a fee-
                        for-service basis; and
                            (iii) receive information and experience in 
                        order to better understand the utility of 
                        medicare hospice services.
                    (C) Eligible medicare beneficiary defined.--
                            (i) In general.--In this paragraph, the 
                        term ``eligible medicare beneficiary'' means 
                        any medicare beneficiary with a serious illness 
                        that has been documented by a physician to be 
                        at a level of severity determined by the 
                        Secretary to meet the criteria developed under 
                        clause (ii).
                            (ii) Development of criteria.--
                                    (I) In general.--The Secretary, in 
                                consultation with hospice providers and 
                                experts in end-of-life care, shall 
                                develop criteria for determining the 
                                level of severity of an established 
                                serious illness taking into account the 
                                factors described in subclause (II).
                                    (II) Factors.--The factors 
                                described in this clause include the 
                                level of function of the medicare 
                                beneficiary, any coexisting illnesses 
                                of the beneficiary, and the severity of 
                                any chronic condition that will lead to 
                                the death of the beneficiary.
                                    (III) Prognosis not a basis for 
                                criteria.--The Secretary may not base 
                                the criteria developed under this 
                                subparagraph on the prognosis of a 
                                medicare beneficiary.
            (4) Conduct of program.--Under the demonstration program, 
        the Secretary shall--
                    (A) accept proposals submitted by any State hospice 
                association;
                    (B)(i) except as provided in clause (ii), conduct 
                the program in at least 3, but not more than 6, 
                geographic areas (which may be statewide) that include 
                both urban and rural hospice providers; and
                    (ii) if a geographic area does not have any rural 
                hospice provider available to participate in the 
                demonstration program, such area may substitute an 
                underserved urban area, but the Secretary shall give 
                priority to those proposals that include a rural 
                hospice provider;
                    (C)(i) except for the geographic area designated 
                under clause (ii), select such geographic areas so that 
                such areas are geographically diverse and readily 
                accessible to a significant number of medicare 
                beneficiaries; and
                    (ii) designate as such an area 1 State in which the 
                largest metropolitan area of such State had the lowest 
                percentage of medicare beneficiary deaths in a hospital 
                compared to the largest metropolitan area of each other 
                State according to the Hospital Referral Region of 
                Residence, 1994-1995, as listed in the Dartmouth Atlas 
                of Health Care 1998;
                    (D) provide for the participation of medicare 
                beneficiaries in such program on a voluntary basis;
                    (E) permit research designs that use time series, 
                sequential implementation of the intervention, 
                randomization by wait list, and other designs that 
allow the strongest possible implementation of the demonstration 
program, while still allowing strong evaluation about the merits of the 
demonstration program; and
                    (F) design the program to facilitate the evaluation 
                conducted under paragraph (6).
            (5) Duration.--The Secretary shall complete the 
        demonstration program within a period of 6\1/2\ years that 
        includes a period of 18 months during which the Secretary shall 
        complete the evaluation under paragraph (6).
            (6) Evaluation.--During the 18-month period following the 
        first 5 years of the demonstration program, the Secretary shall 
        complete an evaluation of the demonstration program in order to 
        determine--
                    (A) the short-term and long-term costs and benefits 
                of changing medicare hospice services to include the 
                items, services, and reimbursement options provided 
                under the demonstration program;
                    (B) whether increases in payments for the medicare 
                hospice benefit are offset by savings in other parts of 
                the medicare program;
                    (C) the projected cost of implementing the 
                demonstration program on a national basis; and
                    (D) in consultation with hospice organizations and 
                hospice providers (including organizations and 
                providers that represent rural areas), whether a 
                payment system based on diagnosis-related groups is 
                useful for administering the medicare hospice benefit.
            (7) Reports to congress.--
                    (A) Preliminary report.--Not later than 3 years 
                after the date of enactment of this Act, the Secretary 
                shall submit a preliminary report to the Committee on 
                Ways and Means of the House of Representatives and to 
                the Committee on Finance of the Senate on the progress 
                made in the demonstration program.
                    (B) Interim report.--Not later than 30 months after 
                the implementation of the demonstration program, the 
                Secretary, in consultation with participants in the 
                program, shall submit an interim report on the 
                demonstration program to the committees described in 
                subparagraph (A).
                    (C) Final report.--Not later than the date on which 
                the demonstration program ends, the Secretary shall 
                submit a final report to the committees described in 
                subparagraph (A) on the demonstration program that 
                includes the results of the evaluation conducted under 
                paragraph (6) and recommendations for appropriate 
                legislative changes.
            (8) Waiver of medicare requirements.--The Secretary shall 
        waive compliance with such requirements of the medicare program 
        to the extent and for the period the Secretary finds necessary 
        for the conduct of the demonstration program.
            (9) Special rules for payment of medicare+choice 
        organizations.--The Secretary shall establish procedures under 
        which the Secretary provides for an appropriate adjustment in 
        the monthly payments made under section 1853 of the Social 
        Security Act (42 U.S.C. 1395w-23) to any Medicare+Choice 
        organization offering a Medicare+Choice plan in which a 
        medicare beneficiary that participates in the demonstration 
        program is enrolled to reflect such participation.
    (c) Hospice Education Grants.--
            (1) In general.--The Secretary shall establish a Hospice 
        Education Grant program under which the Secretary awards 
        education grants to entities participating in the demonstration 
        program for the purpose of providing information about--
                    (A) the medicare hospice benefit; and
                    (B) the benefits available to medicare 
                beneficiaries under the demonstration program.
            (2) Use of funds.--Grants awarded pursuant to paragraph (1) 
        shall be used--
                    (A) to provide--
                            (i) individual or group education to 
                        medicare beneficiaries and their families; and
                            (ii) individual or group education of the 
                        medical and mental health community caring for 
                        medicare beneficiaries; and
                    (B) to test strategies to improve the general 
                public knowledge about the medicare hospice benefit and 
                the benefits available to medicare beneficiaries under 
                the demonstration program.
    (d) Funding.--
            (1) Hospice demonstration program.--
                    (A) In general.--Except as provided in subparagraph 
                (B), expenditures made for the demonstration program 
                shall be in lieu of the funds that would have been 
                provided to participating hospices under section 
                1814(i) of the Social Security Act (42 U.S.C. 
                1395f(i)).
                    (B) Supportive and comfort care benefit.--The 
                Secretary shall pay any expenses for the supportive and 
                comfort care benefit established under subsection 
                (a)(3) from the Federal Hospital Insurance Trust Fund 
                established under section 1817 of the Social Security 
                Act (42 U.S.C. 1395i) and the Federal Supplementary 
                Medical Insurance Trust Fund established under section 
                1841 of such Act (42 U.S.C. 1395t), in such proportion 
                as the Secretary determines is appropriate.
            (2) Hospice education grants.--The Secretary is authorized 
        to expend such sums as may be necessary for the purposes of 
        carrying out the Hospice Education Grant program established 
        under subsection (c)(1) from the Research and Demonstration 
        Budget of the Health Care Financing Administration.
                                 <all>
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