I 
116TH CONGRESS 
2D SESSION 
H. R. 5821 
To amend title XVIII of the Social Security Act to establish hospice program 
survey and enforcement procedures under the Medicare program, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 10, 2020 
Mr. PANETTA (for himself, Mr. REED, and Mr. HIGGINS of New York) intro-
duced the following bill; which was referred to the Committee on Ways 
and Means, and in addition to the Committee on Energy and 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 establish 
hospice program survey and enforcement procedures 
under the Medicare program, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Helping Our Senior 
Population in Comfort Environments Act’’ or the ‘‘HOS-
PICE Act’’. 
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SEC. 2. ESTABLISHING HOSPICE PROGRAM SURVEY AND 
ENFORCEMENT PROCEDURES UNDER THE 
MEDICARE PROGRAM. 
(a) SURVEY AND ENFORCEMENT PROCEDURES.— 
(1) IN GENERAL.—Part A of title XVIII of the 
Social Security Act (42 U.S.C. 1395c et seq.) is 
amended by adding at the end the following new sec-
tion: 
‘‘SEC. 1822. HOSPICE PROGRAM SURVEY AND ENFORCE-
MENT PROCEDURES. 
‘‘(a) SURVEYS.— 
‘‘(1) FREQUENCY.—Any entity that is certified 
as a hospice program shall be subject to a standard 
survey by an appropriate State or local survey agen-
cy, or an approved accreditation agency, as deter-
mined by the Secretary, not less frequently than 
once every 36 months (and not less frequently than 
once every 24 months beginning October 1, 2021). 
‘‘(2) PUBLIC TRANSPARENCY OF SURVEY AND 
CERTIFICATION INFORMATION.— 
‘‘(A) SUBMISSION
OF
INFORMATION
TO 
THE SECRETARY.— 
‘‘(i) IN GENERAL.—Each State, and 
each national accreditation body with re-
spect to which the Secretary has made a 
finding under section 1865(a) respecting 
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the accreditation of a hospice program by 
such body, shall submit, in a form and 
manner, and at a time, specified by the 
Secretary for purposes of this subpara-
graph, information respecting any survey 
or certification made with respect to a hos-
pice program by such State or body, as ap-
plicable. Such information shall include 
any inspection report made by such State 
or body with respect to such survey or cer-
tification, any enforcement actions taken 
as a result of such survey or certification, 
and any other information determined ap-
propriate by the Secretary. 
‘‘(ii) REQUIRED INCLUSION OF SPECI-
FIED
FORM.—With respect to a survey 
under this subsection carried out by a na-
tional accreditation body described in 
clause (i) on or after October 1, 2021, in-
formation described in such clause shall in-
clude Form 2567 (or a successor form), 
along with such additional information de-
termined appropriate by such body. 
‘‘(B) PUBLIC
DISCLOSURE
OF
INFORMA-
TION.—Beginning not later than October 1, 
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2022, the Secretary shall publish the informa-
tion submitted under subparagraph (A) on the 
public website of the Centers for Medicare & 
Medicaid Services in a manner that is promi-
nent, easily accessible, readily understandable, 
and searchable. The Secretary shall provide for 
the timely update of such information so pub-
lished. 
‘‘(3) CONSISTENCY OF SURVEYS.—Each State 
and the Secretary shall implement programs to 
measure and reduce inconsistency in the application 
of survey results among surveyors. 
‘‘(4) SURVEY TEAMS.— 
‘‘(A) IN GENERAL.—In the case of a sur-
vey conducted under this subsection on or after 
October 1, 2021, by more than 1 individual, 
such survey shall be conducted by a multidisci-
plinary team of professionals (including a reg-
istered professional nurse). 
‘‘(B) PROHIBITION OF CONFLICTS OF IN-
TEREST.—Beginning October 1, 2021, a State 
may not use as a member of a survey team 
under this subsection an individual who is serv-
ing (or has served within the previous 2 years) 
as a member of the staff of, or as a consultant 
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to, the program surveyed respecting compliance 
with the requirements of section 1861(dd) or 
who has a personal or familial financial interest 
in the program being surveyed. 
‘‘(C) TRAINING.—The Secretary shall pro-
vide, not later than October 1, 2021, for the 
comprehensive training of State and Federal 
surveyors in the conduct of surveys under this 
subsection, including training with respect to 
the review of written plans for providing hospice 
care (as described in section 1814(a)(7)(B)). 
No individual shall serve as a member of a sur-
vey team with respect to a survey conducted on 
or after such date unless the individual has suc-
cessfully completed a training and testing pro-
gram in survey and certification techniques that 
has been approved by the Secretary. 
‘‘(5) FUNDING.—The Secretary shall provide 
for the transfer, from the Federal Hospital Insur-
ance Trust Fund under section 1817 to the Centers 
for Medicare & Medicaid Program Management Ac-
count, of $10,000,000 for each fiscal year (begin-
ning with fiscal year 2022) for purposes of carrying 
out surveys under this subsection. Sums so trans-
ferred shall remain available until expended. Any 
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transfer pursuant to this paragraph shall be in addi-
tion to any transfer pursuant to section 3(a)(2) of 
the Improving Medicare Post-Acute Care Trans-
formation Act of 2014. 
‘‘(b) SPECIAL FOCUS PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall con-
duct a special focus program for enforcement of re-
quirements for hospice programs that the Secretary 
has identified as having substantially failed to meet 
applicable requirements of this Act. 
‘‘(2) PERIODIC SURVEYS.—Under such special 
focus program, the Secretary shall conduct surveys 
of each hospice program in the special focus pro-
gram not less than once every 6 months. 
‘‘(c) ENFORCEMENT.— 
‘‘(1) SITUATIONS INVOLVING IMMEDIATE JEOP-
ARDY.—If the Secretary determines on the basis of 
a standard survey or otherwise that a hospice pro-
gram that is certified for participation under this 
title is no longer in compliance with the require-
ments specified in section 1861(dd) and determines 
that the deficiencies involved immediately jeopardize 
the health and safety of the individuals to whom the 
program furnishes items and services, the Secretary 
shall take immediate action to remove the jeopardy 
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and correct the deficiencies through the remedy de-
scribed in paragraph (5)(B)(iii) or terminate the cer-
tification of the program, and may provide, in addi-
tion, for one or more of the other remedies described 
in paragraph (5)(B). 
‘‘(2) SITUATIONS NOT INVOLVING IMMEDIATE 
JEOPARDY.—If the Secretary determines on the 
basis of a standard survey or otherwise that a hos-
pice program that is certified for participation under 
this title is no longer in compliance with the require-
ments specified in section 1861(dd) and determines 
that the deficiencies involved do not immediately 
jeopardize the health and safety of the individuals to 
whom the program furnishes items and services, the 
Secretary may (for a period not to exceed 6 months) 
impose remedies developed pursuant to paragraph 
(5)(A), in lieu of terminating the certification of the 
program. If, after such a period of remedies, the 
program is still no longer in compliance with such 
requirements, the Secretary shall terminate the cer-
tification of the program. 
‘‘(3) PENALTY
FOR
PREVIOUS
NONCOMPLI-
ANCE.—If the Secretary determines that a hospice 
program that is certified for participation under this 
title is in compliance with the requirements specified 
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in section 1861(dd) but, as of a previous period, did 
not meet such requirements, the Secretary may pro-
vide for a civil monetary penalty under paragraph 
(5)(B)(i) for the days in which the Secretary finds 
that the program was not in compliance with such 
requirements. 
‘‘(4) OPTION
TO
CONTINUE
PAYMENTS
FOR 
NONCOMPLIANT
HOSPICE
PROGRAMS.—The Sec-
retary may continue payments under this title with 
respect to a hospice program not in compliance with 
the requirements specified in section 1861(dd) over 
a period of not longer than 6 months, if— 
‘‘(A) the State or local survey agency finds 
that it is more appropriate to take alternative 
action to assure compliance of the program with 
such requirements than to terminate the certifi-
cation of the program; 
‘‘(B) the program has submitted a plan 
and timetable for corrective action to the Sec-
retary for approval and the Secretary approves 
the plan of corrective action; and 
‘‘(C) the program agrees to repay to the 
Federal Government payments received under 
this title during such period if the corrective ac-
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tion is not taken in accordance with the ap-
proved plan and timetable. 
The Secretary shall establish guidelines for approval 
of corrective actions requested by hospice programs 
under this paragraph. 
‘‘(5) REMEDIES.— 
‘‘(A) DEVELOPMENT.— 
‘‘(i) IN GENERAL.—Not later than Oc-
tober 1, 2021, the Secretary shall develop 
and implement— 
‘‘(I) a range of remedies to apply 
to hospice programs under the condi-
tions described in paragraphs (1) 
through (4); and 
‘‘(II) appropriate procedures for 
appealing determinations relating to 
the imposition of such remedies. 
Remedies developed pursuant to the pre-
ceding sentence shall include the remedies 
specified in subparagraph (B). 
‘‘(ii) CONDITIONS OF IMPOSITION OF 
REMEDIES.—Not later than October 1, 
2021, the Secretary shall develop and im-
plement specific procedures with respect to 
the conditions under which each of the 
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remedies developed under clause (i) is to 
be applied, including the amount of any 
fines and the severity of each of these rem-
edies. Such procedures shall be designed so 
as to minimize the time between identifica-
tion of deficiencies and imposition of these 
remedies and shall provide for the imposi-
tion of incrementally more severe fines for 
repeated or uncorrected deficiencies. 
‘‘(B) SPECIFIED
REMEDIES.—The rem-
edies specified in this subparagraph are the fol-
lowing: 
‘‘(i) Civil monetary penalties in an 
amount not to exceed $10,000 for each day 
of noncompliance by a hospice program 
with the requirements specified in section 
1861(dd). 
‘‘(ii) Suspension of all or part of the 
payments to which a hospice program 
would otherwise be entitled under this title 
with respect to items and services fur-
nished by a hospice program on or after 
the date on which the Secretary determines 
that remedies should be imposed pursuant 
to paragraph (2). 
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‘‘(iii) The appointment of temporary 
management to oversee the operation of 
the hospice program and to protect and as-
sure the health and safety of the individ-
uals under the care of the program while 
improvements are made in order to bring 
the program into compliance with all such 
requirements. 
‘‘(C) PROCEDURES.— 
‘‘(i) CIVIL MONETARY PENALTIES.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the provisions of sec-
tion 1128A (other than subsections 
(a) and (b)) shall apply to a civil mon-
etary penalty under this subsection in 
the same manner as such provisions 
apply to a penalty or proceeding 
under section 1128A(a). 
‘‘(II) RETENTION
OF
AMOUNTS 
FOR
HOSPICE
PROGRAM
IMPROVE-
MENTS.—The Secretary may provide 
that any portion of civil monetary 
penalties collected under this sub-
section may be used to support activi-
ties that benefit individuals receiving 
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hospice care, including education and 
training programs to ensure hospice 
program compliance with the require-
ments of section 1861(dd). 
‘‘(ii) SUSPENSION
OF
PAYMENT.—A 
finding to suspend payment under sub-
paragraph (B)(ii) shall terminate when the 
Secretary finds that the program is in sub-
stantial compliance with all such require-
ments. 
‘‘(iii) TEMPORARY
MANAGEMENT.— 
The temporary management under sub-
paragraph (B)(iii) shall not be terminated 
until the Secretary has determined that the 
program has the management capability to 
ensure continued compliance with all the 
requirements referred to in such subpara-
graph. 
‘‘(D) RELATIONSHIP
TO
OTHER
REM-
EDIES.—The remedies developed under sub-
paragraph (A) are in addition to sanctions oth-
erwise available under State or Federal law and 
shall not be construed as limiting other rem-
edies, including any remedy available to an indi-
vidual at common law.’’. 
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in effect as of, the date that is 1 year after the 
date of the enactment of this Act. 
(4) CONFORMING AMENDMENTS.— 
(A) DEFINITION
OF
A
HOSPICE
PRO-
GRAM.—Section 1861(dd)(4) of the Social Secu-
rity Act (42 U.S.C. 1395x(dd)(4)) is amended 
by striking subparagraph (C). 
(B) CONTINUATION OF FUNDING.—Section 
3(a)(2) of the Improving Medicare Post-Acute 
Care Transformation Act of 2014 is amended 
by inserting ‘‘and section 1822(a)(1) of such 
Act,’’ after ‘‘as added by paragraph (1),’’. 
(b) INCREASING PAYMENT REDUCTIONS FOR FAIL-
URE TO MEET QUALITY DATA REPORTING REQUIRE-
MENTS.—Section 1814(i)(5)(A)(i) of the Social Security 
Act (42 U.S.C. 1395f(i)(5)(A)(i)) is amended by inserting 
‘‘(or, for fiscal year 2023 and each subsequent fiscal year, 
4 percentage points)’’ before the period. 
(c) REPORT.—Not later than October 1, 2024, the 
Comptroller General of the United States shall submit to 
the Committee on Ways and Means of the House of Rep-
resentatives and the Committee on Finance of the Senate 
a report containing an analysis of the effects of the 
amendments made by subsection (a), including the fre-
quency of application of remedies specified in section 
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1822(c)(5)(B) of the Social Security Act (as added by 
such subsection), on access to, and quality of, care fur-
nished by hospice programs under part A of title XVIII 
of the Social Security Act (42 U.S.C. 1395c et seq.). 
Æ 
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