I

104TH CONGRESS

2D SESSION H. R. 3714

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

to hospice care under the Medicare program.

IN THE HOUSE OF REPRESENTATIVES

JUNE 25, 1996

Mr. CARDIN (for himself, Mr. PORTMAN, Mr. ENGLISH of Pennsylvania, Mr.

JACOBS, and Mr. MCNULTY) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the

Committee on Commerce, for a period to be subsequently determined by

the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

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

2 a subsequent period of 30 days, and a subsequent exten3 sion period’’ and inserting ‘‘and an unlimited number of

4 subsequent periods of 60 days each’’.

5 (b) CONFORMING AMENDMENTS.—(1) Section 1812

6 of such Act (42 U.S.C. 1395d) is amended in subsection

7 (d)(2)(B) by striking ‘‘90- or 30-day period or a subse8 quent extension period’’ and inserting ‘‘90-day period or

9 a subsequent 60-day period’’.

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

11 1395f(a)(7)(A)) is amended—

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

13 (B) in clause (ii)—

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

15 day’’; and

16 (ii) by striking ‘‘and’’ at the end and in17 serting a period; and

18 (C) by striking clause (iii).

19 SEC. 3. AMBULANCE SERVICES, DIAGNOSTIC TESTS, CHEM20 OTHERAPY SERVICES, AND RADIATION THER21 APY SERVICES INCLUDED IN HOSPICE CARE.

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

23 U.S.C. 1395x(dd)(1)) is amended—
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1 (1) in subparagraph (E), by inserting

2 ‘‘anticancer chemotherapeutic agents and other’’ be3 fore ‘‘drugs’’;

4 (2) in subparagraph (G), by striking ‘‘and’’ at

5 the end;

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

7 at the end and inserting a comma; and

8 (4) by inserting after subparagraph (H) the fol9 lowing:

10 ‘‘(I) ambulance services,

11 ‘‘(J) diagnostic tests, and

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

13 SEC. 4. CONTRACTING WITH INDEPENDENT PHYSICIANS

14 OR PHYSICIAN GROUPS FOR HOSPICE CARE

15 SERVICES PERMITTED.

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

17 U.S.C. 1395x(dd)(2)) is amended—

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

19 ‘‘(F),’’; and

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

21 under contract with’’ after ‘‘employed by’’.
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1 SEC. 5. WAIVER OF CERTAIN STAFFING REQUIREMENTS

2 FOR HOSPICE CARE PROGRAMS IN NON-UR3 BANIZED AREAS.

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

5 U.S.C. 1395x(dd)(5)) is amended—

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

7 after ‘‘subparagraph (A)’’ each place it appears; and

8 (2) by adding at the end the following:

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

10 paragraph (2)(A)(i) and (2)(A)(ii) for an agency or orga11 nization with respect to the services described in para12 graph (1)(B) and, with respect to dietary counseling,

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

14 ‘‘(i) is located in an area which is not an urban15 ized area (as defined by the Bureau of Census), and

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

17 Secretary that the agency or organization has been

18 unable, despite diligent efforts, to recruit appro19 priate personnel.’’.

20 SEC. 6. LIMITATION ON LIABILITY OF BENEFICIARIES AND

21 PROVIDERS FOR CERTAIN HOSPICE COV22 ERAGE DENIALS.

23 (a) IN GENERAL.—Section 1879(g) of the Social Se24 curity Act (42 U.S.C. 1395pp(g)) is amended—
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1 (1) by redesignating paragraphs (1) and (2) as

2 subparagraphs (A) and (B), respectively, and mov3 ing such subparagraphs 2 ems to the right;

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

5 (3) by making the remaining text of subsection

6 (g), as amended, that follows ‘‘is—’’ a new para7 graph (1) and indenting such paragraph 2 ems to

8 the right;

9 (4) by striking the period at the end and insert10 ing ‘‘; and’’; and

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

12 paragraph:

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

14 care to an individual, a determination that the indi15 vidual is not terminally ill.’’.

16 (b) WAIVER PERIOD EXTENDED.—Section

17 9305(f)(2) of the Omnibus Budget Reconciliation Act of

18 1986 is amended by striking ‘‘and before December 31,

19 1995.’’.

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

21 this section take effect December 31, 1995.
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1 SEC. 7. EXTENDING THE PERIOD FOR PHYSICIAN CERTIFI2 CATION OF AN INDIVIDUAL’S TERMINAL ILL3 NESS.

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

5 Act (42 U.S.C. 1395f(a)(7)(A)(i)(II)) is amended by strik6 ing ‘‘, not later than 2 days after hospice care is initiated

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

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

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

10 period’’.

11 SEC. 8. EFFECTIVE DATE.

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

13 made by this Act apply to benefits provided on or after

14 the date of the enactment of this Act, regardless of wheth15 er or not an individual has made an election under section

16 1812(d) of the Social Security Act before such date.

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