II 

112TH CONGRESS 

1ST SESSION S. 722 

To strengthen and protect Medicare hospice programs. 

IN THE SENATE OF THE UNITED STATES 

APRIL 4, 2011 

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 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’’. 

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: 

10 ‘‘(i) a hospice physician, a nurse prac11 titioner, a clinical nurse specialist, or a 

12 physician assistant (as those terms are deVerDate Mar 15 2010 23:48 Apr 05, 2011 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S722.IS S722

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1 fined in section 1861(aa)(5)), or other 

2 health professional (as designated by the 

3 Secretary), has a face-to-face encounter 

4 with the individual to determine continued 

5 eligibility of the individual for hospice care 

6 prior to the first 60-day period and each 

7 subsequent recertification under subpara8 graph (A)(ii) (or, in the case where a hos9 pice program newly admits an individual 

10 who would be entering their first 60-day 

11 period or a subsequent hospice benefit pe12 riod or where exceptional circumstances, as 

13 defined by the Secretary, may prevent a 

14 face-to-face encounter prior to the begin15 ning of the hospice benefit period, not later 

16 than 7 calendar days after the individual’s 

17 election under section 1812(d)(1) with re18 spect to the hospice program) and attests 

19 that such visit took place (in accordance 

20 with procedures established by the Sec21 retary); and’’. 

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

23 subsection (a) takes effect on the date of enactment of 

24 this Act and applies to hospice care furnished on or after 

25 such date. 


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1 SEC. 3. RESTORING AND PROTECTING THE MEDICARE HOS2 PICE BENEFIT. 

3 (a) IN GENERAL.—Section 1814(i) of the Social Se4 curity Act (42 U.S.C. 1395f(i)) is amended— 

5 (1) in subparagraph (1)(C)— 

6 (A) in clause (ii)— 

7 (i) in the matter preceding subclause 

8 (I), by striking ‘‘(6)(D)’’ and inserting 

9 ‘‘(6)(E)’’; and 

10 (ii) in subclause (VII), by striking 

11 ‘‘(6)(D)’’ and inserting ‘‘(6)(E)’’; and 

12 (B) in clause (iii), by moving such clause 

13 6 ems to the left and striking ‘‘(6)(D)’’ and in14 serting ‘‘(6)(E)’’; and 

15 (2) in paragraph (6)— 

16 (A) in subparagraph (A), by striking ‘‘sub17 paragraph (D)’’ and inserting ‘‘subparagraph 

18 (E)’’; 

19 (B) by redesignating subparagraphs (D) 

20 and (E) as subparagraphs (E) and (F), respec21 tively, and inserting after subparagraph (C) the 

22 following new subparagraph: 

23 ‘‘(D) HOSPICE PAYMENT REFORM DEM24 ONSTRATION PROGRAM.— 

25 ‘‘(i) ESTABLISHMENT OF DEM26 ONSTRATION PROGRAM.— 


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1 ‘‘(I) IN GENERAL.—Prior to im2 plementing any revisions to the meth3 odology for determining the payment 

4 rates for routine home care and other 

5 services included in hospice care 

6 under subparagraph (E), the Sec7 retary shall establish a Medicare Hos8 pice Payment Reform demonstration 

9 program to test such proposed revi10 sions. 

11 ‘‘(II) DURATION.—The dem12 onstration program shall be conducted 

13 for a 2-year period beginning on or 

14 after October 1, 2013. 

15 ‘‘(III) SCOPE.—The Secretary 

16 shall select not more than 15 hospice 

17 programs at which the demonstration 

18 program under this subparagraph 

19 shall be conducted. 

20 ‘‘(IV) REPRESENTATIVE PARTICI21 PATION.—Hospice programs selected 

22 under subclause (III) to participate in 

23 the demonstration program shall in24 clude a representative cross-section of 

25 such programs throughout the United 


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1 States, including programs located in 

2 urban and rural areas. 

3 ‘‘(V) VOLUNTARY PARTICIPA4 TION.—Hospice program participation 

5 in the demonstration program shall be 

6 on a voluntary basis. 

7 ‘‘(ii) EVALUATION AND REPORT.— 

8 ‘‘(I) EVALUATION.—The Sec9 retary shall conduct an evaluation of 

10 the demonstration program under this 

11 subparagraph. Such evaluation shall 

12 include an analysis of whether the use 

13 of the revised payment methodology 

14 under the demonstration program has 

15 improved the quality of patient care 

16 and access to hospice services for 

17 beneficiaries under this title and the 

18 impact of such payment revisions on 

19 hospice care providers, including the 

20 impact, if any, on the ability of hos21 pice programs to furnish quality care 

22 to beneficiaries under this title. 

23 ‘‘(II) REPORT.—Not later than 1 

24 year after the completion of the dem25 onstration program, the Secretary 


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1 shall submit to Congress a report con2 taining the results of the evaluation 

3 conducted under subclause (I), to4 gether with recommendations for such 

5 legislation and administrative action 

6 as the Secretary determines appro7 priate. 

8 ‘‘(iii) BUDGET NEUTRALITY.—With 

9 respect to the 2-year period of the dem10 onstration program under this subpara11 graph, the Secretary shall ensure that the 

12 estimated amount of aggregate payments 

13 under this title to each hospice program 

14 participating in the demonstration pro15 gram for such period shall not be more 

16 than 5 percent higher or 5 percent lower 

17 than the estimated amount of aggregate 

18 payments that would have been made 

19 under this title to each such hospice pro20 gram during such period had they not par21 ticipated in the demonstration program 

22 under this subparagraph.’’. 

23 (C) in subparagraph (E), as redesignated 

24 by subparagraph (B)— 

25 (i) in clause (i)— 


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1 (I) in the first sentence, by strik2 ing ‘‘October 1, 2013, the Secretary 

3 shall, by regulation’’ and inserting 

4 ‘‘subject to clause (iii), the later of 2 

5 years after the demonstration pro6 gram under subparagraph (D) is com7 pleted or October 1, 2017, the Sec8 retary shall, by regulation, preceded 

9 by notice of the proposed regulation in 

10 the Federal Register and a period for 

11 public comment in accordance with 

12 section 1871(b)(1),’’; and 

13 (II) in the second sentence, by 

14 inserting ‘‘, and shall take into ac15 count the results of the evaluation 

16 conducted under subparagraph 

17 (D)(ii)’’ before the period; and 

18 (ii) by adding at the end the following 

19 new clause: 

20 ‘‘(iii) In no case may the Secretary imple21 ment any revisions in payment pursuant to 

22 clause (i) unless the Secretary determines that 

23 the demonstration program under subparagraph 

24 (D) demonstrated that such revisions would not 


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1 adversely affect access to quality hospice care 

2 by beneficiaries under this title.’’. 

3 (D) in subparagraph (F), as redesignated 

4 by subparagraph (B), by striking ‘‘subpara5 graph (D)’’ and inserting ‘‘subparagraph (E)’’. 

6 SEC. 4. HOSPICE SURVEY REQUIREMENT. 

7 (a) IN GENERAL.—Section 1861(dd)(4) of the Social 

8 Security Act (42 U.S.C. 1395x(dd)(4)) is amended by 

9 adding at the end the following new subparagraph: 

10 ‘‘(C) Any entity seeking certification as a hospice pro11 gram shall be subject to an initial survey by an appro12 priate State or local survey agency, or an approved accred13 itation agency, as determined by the Secretary, not later 

14 than 6 months after beginning operations, and any entity 

15 which is certified as a hospice program shall be subject 

16 to a standard survey not less frequently than every 36 

17 months.’’. 

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

19 subsection (a) takes effect on the date that is 180 days 

20 after the date of enactment of this Act and applies to hos21 pice programs on or after such date. 

Æ 


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