I

105TH CONGRESS

1ST SESSION H. R. 521

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

FEBRUARY 4, 1997

Mr. CARDIN (for himself, Mr. PORTMAN, Mrs. KENNELLY of Connecticut, Ms.

FURSE, Mr. ACKERMAN, Mr. UNDERWOOD, Mr. STARK, Mr. SOLOMON,

Mrs. CLAYTON, Mr. MILLER of Florida, Ms. SLAUGHTER, Mr. TOWNS,

Mr. GUTIERREZ, Mr. LAFALCE, Mr. HALL of Ohio, Mr. EVANS, Mr.

FROST, Mr. LEWIS of Georgia, Mr. ENGLISH of Pennsylvania, Mrs.

THURMAN, Mr. POSHARD, Mr. QUINN, Mr. WYNN, Mr. GRAHAM, Ms.

PRYCE of Ohio, Mr. MASCARA, Mr. MATSUI, Mr. NEY, Mr. LAZIO of New

York, Mr. MCDERMOTT, Ms. WOOLSEY, Mr. MCNULTY, Mr. STENHOLM,

Mr. GILLMOR, Mr. CONDIT, Mr. GEJDENSON, Mr. SKAGGS, Ms. CHRISTIAN-GREEN, Mr. WATT of North Carolina, Mr. BARRETT of Wisconsin,

Mr. ABERCROMBIE, Mr. RUSH, Mr. GREENWOOD, Ms. DUNN, Mrs.

MALONEY of New York, Mr. FAZIO of California, Mr. LEWIS of Kentucky, Mr. HOLDEN, Mr. FOLEY, Mr. FOGLIETTA, Mr. OLVER, Mr.

DELAHUNT, Mr. BURR of North Carolina, Mr. BUNNING, Mr. YATES,

Mr. RAHALL, Mr. WISE, Mr. TORRES, and Mr. SANDERS) 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,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Medicare Hospice Ben3 efit Amendments of 1997’’.

4 SEC. 2. HOSPICE CARE BENEFIT PERIODS.

5 (a) RESTRUCTURING OF BENEFIT PERIOD.—Section

6 1812 of the Social Security Act (42 U.S.C. 1395d) is

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

8 a subsequent period of 30 days, and a subsequent exten9 sion period’’ and inserting ‘‘and an unlimited number of

10 subsequent periods of 60 days each’’.

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

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

13 (d)(2)(B) by striking ‘‘90- or 30-day period or a subse14 quent extension period’’ and inserting ‘‘90-day period or

15 a subsequent 60-day period’’.

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

17 1395f(a)(7)(A)) is amended—

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

19 (B) in clause (ii)—

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

21 day’’; and

22 (ii) by striking ‘‘, and’’ at the end and in23 serting a period; and

24 (C) by striking clause (iii).
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1 SEC. 3. OTHER ITEMS AND SERVICES INCLUDED IN HOS2 PICE CARE.

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

4 U.S.C. 1395x(dd)(1)) is amended—

5 (1) in subparagraph (G), by striking ‘‘and’’ at

6 the end;

7 (2) in subparagraph (H), by striking the period

8 at the end and inserting ‘‘, and’’; and

9 (3) by inserting after subparagraph (H) the fol10 lowing:

11 ‘‘(I) any other item or service which is specified

12 in the plan and for which payment may otherwise be

13 made under this title.’’.

14 SEC. 4. CONTRACTING WITH INDEPENDENT PHYSICIANS

15 OR PHYSICIAN GROUPS FOR HOSPICE CARE

16 SERVICES PERMITTED.

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

18 U.S.C. 1395x(dd)(2)) is amended—

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

20 ‘‘(F),’’; and

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

22 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 Section 1879(g) of the Social Security Act (42 U.S.C.

24 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 SEC. 7. EXTENDING THE PERIOD FOR PHYSICIAN CERTIFI17 CATION OF AN INDIVIDUAL’S TERMINAL ILL18 NESS.

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

20 Act (42 U.S.C. 1395f(a)(7)(A)(i)(II)) is amended by strik21 ing ‘‘, not later than 2 days after hospice care is initiated

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

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

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

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

2 The amendments made by this Act apply to benefits

3 provided on or after the date of the enactment of this Act,

4 regardless of whether or not an individual has made an

5 election under section 1812(d) of the Social Security Act

6 (42 U.S.C. 1395d(d)) before such date.

Æ