I 
118TH CONGRESS 
2D SESSION 
H. R. 9803 
To amend title XVIII of the Social Security Act to ensure the integrity 
of hospice care furnished under the Medicare program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 25, 2024 
Mr. BLUMENAUER introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on En-
ergy 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 ensure 
the integrity of hospice care furnished under the Medi-
care 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 ‘‘Hospice Care Account-
ability, Reform, and Enforcement Act of 2024’’ or the 
‘‘Hospice CARE Act of 2024’’. 
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SEC. 2. ENSURING THE INTEGRITY OF HOSPICE CARE FUR-
NISHED UNDER THE MEDICARE PROGRAM. 
(a) MANDATORY TEMPORARY MORATORIUM ON EN-
ROLLMENT.— 
(1) IN GENERAL.—Section 1866(j) of the Social 
Security Act (42 U.S.C. 1395cc(j)) is amended by 
adding at the end the following new paragraph: 
‘‘(10) MANDATORY
TEMPORARY
MORATORIUM 
ON ENROLLMENT OF HOSPICE PROGRAMS.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraphs (B) and (C), the Secretary shall 
impose a nationwide temporary moratorium on 
the enrollment of new hospice programs under 
this title for the 5-year period beginning on the 
date of the enactment of this paragraph. 
‘‘(B) EXEMPTION
FOR
CERTAIN
HOS-
PICES.— 
‘‘(i) IN
GENERAL.—The Secretary 
may exempt a hospice program seeking to 
enroll under this title from the moratorium 
described in subparagraph (A) if the Sec-
retary determines that such program will 
furnish hospice care to individuals entitled 
to benefits under part A in an area with 
insufficient access to such care (as speci-
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fied by the Secretary, taking into account 
the considerations described in clause (ii)). 
‘‘(ii) CONSIDERATIONS DESCRIBED.— 
For purposes of clause (i), the consider-
ations described in this clause are, with re-
spect to a hospice program seeking to en-
roll under this title, the following: 
‘‘(I) The specific geographic area 
that such program intends to serve. 
‘‘(II) The current availability of 
hospice care in such area. 
‘‘(III) Any evidence of unmet 
need for hospice care in such area 
(such as wait times for such care, the 
extent to which such area (or a popu-
lation in such area) is considered un-
derserved, and evidence that existing 
hospice programs are provided a sub-
standard quality of care in such area). 
‘‘(IV) The program’s plan to ad-
dress any identified gaps in the provi-
sion of hospice care in such area. 
‘‘(C) AUTHORITY TO LIFT MORATORIUM.— 
The Secretary may lift the moratorium imposed 
under subparagraph (A) within a State (or geo-
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graphic region of a State) specified by the Sec-
retary in the same manner as the Secretary 
may lift a temporary moratorium (as described 
in paragraph (7)) under section 424.570(d) of 
title 42, Code of Federal Regulations (or a suc-
cessor regulation). 
‘‘(D) APPLICATION OF PREPAYMENT MED-
ICAL REVIEW DURING THE TEMPORARY MORA-
TORIUM IN CERTAIN CIRCUMSTANCES.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), the Secretary shall apply prepayment 
medical review to hospice care consisting of 
routine home care furnished during the 5- 
year period beginning on the date of the 
enactment of this paragraph by an applica-
ble hospice program to a covered indi-
vidual. 
‘‘(ii) TERMINATION
OF
APPLICATION 
OF PREPAYMENT MEDICAL REVIEW.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall terminate the application 
of prepayment medical review under 
clause (i) with respect to hospice care 
furnished by an applicable hospice 
program to a covered individual if the 
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Secretary determines that, during the 
period in which such care so furnished 
by such program was subject to such 
review, such care was subject to a low 
rate of denial (as specified by the Sec-
retary) under such review. 
‘‘(II) REVOCATION
OF
TERMI-
NATION.—The Secretary may revoke 
any termination of prepayment med-
ical review under subclause (I) if de-
termined appropriate by the Sec-
retary. 
‘‘(iii) DEFINITIONS.—For purposes of 
this subparagraph: 
‘‘(I) APPLICABLE HOSPICE PRO-
GRAM.—The term ‘applicable hospice 
program’ means a hospice program 
with a history of claim submissions 
with respect to hospice care furnished 
under this title that is aberrant (such 
as by demonstrating that such pro-
gram is an outlier with respect to live 
discharges) compared to such history 
of claim submissions of similarly situ-
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ated hospice programs, as determined 
by the Secretary. 
‘‘(II) COVERED
INDIVIDUAL.— 
The term ‘covered individual’ means 
an individual receiving hospice care 
under this title during the second 90- 
day 
period 
described 
in 
section 
1812(d)(1) (or during any subsequent 
period) applicable to such individual. 
‘‘(E) REVALIDATION OF ENROLLMENT IN-
FORMATION.— 
‘‘(i) IN
GENERAL.—During the 6- 
month period beginning on the date of the 
enactment of this paragraph and notwith-
standing any applicable revalidation cycle 
under section 424.515 of title 42, Code of 
Federal Regulations (or a successor regula-
tion), the Secretary shall revalidate the en-
rollment information of each hospice pro-
gram enrolled under this title in accord-
ance with the requirements applicable to 
revalidations of such information under 
such section. 
‘‘(ii) PUBLICATION OF OWNERSHIP IN-
FORMATION.—Not later than 1 year after 
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the date of the enactment of this para-
graph, the Secretary shall publish on a 
public website of the Centers for Medicare 
& Medicaid Services ownership interest and 
managing control information collected 
pursuant to revalidations described in 
clause (i) for each hospice program en-
rolled under this title. 
‘‘(iii) REPORT.—Not later than Janu-
ary 1, 2027, the Secretary, acting through 
the Assistant Secretary for Planning and 
Evaluation, shall submit to Congress a re-
port on hospice ownership and control 
trends and the role of private equity in 
ownership and control of hospice programs. 
Such report shall include— 
‘‘(I) validation, to the extent fea-
sible, of the ownership and control in-
formation reported on form CMS– 
855A (or any successor form); 
‘‘(II) an analysis of hospice cost 
report data by ownership type; 
‘‘(III) recommendations on ways 
to improve the integrity of the owner-
ship and control information reported 
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by hospices during the enrollment 
process under this title; and 
‘‘(IV) to the extent practicable, 
recommendations on policies to pro-
mote health care competition. 
‘‘(F) IMPLEMENTATION.—The Secretary 
shall implement this paragraph through pro-
gram instruction or other forms of subregu-
latory guidance.’’. 
(2) AUTHORITY TO PROVIDE EXEMPTIONS TO 
TEMPORARY MORATORIA.—Section 1866(j)(7) of the 
Social Security Act (42 U.S.C. 1395cc(j)(7)) is 
amended— 
(A) in subparagraph (A), by adding at the 
end the following new sentence: ‘‘The Secretary 
may exempt a provider of services or supplier 
that would otherwise be subject to a morato-
rium imposed under the preceding sentence 
from such moratorium if determined appro-
priate by the Secretary.’’; and 
(B) in subparagraph (C)(iii)— 
(i) in subclause (I), by striking ‘‘and’’ 
at the end; 
(ii) in subclause (II), by striking the 
period and inserting ‘‘; and’’; and 
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(iii) by adding at the end the fol-
lowing new subclause: 
‘‘(III) is not subject to an exemp-
tion 
described 
in 
such 
subpara-
graph.’’. 
(b) EXTENSION
OF OVERSIGHT
OF NEWLY-EN-
ROLLED HOSPICE PROGRAMS.— 
(1) IN GENERAL.—Section 1866(j)(3)(A) of the 
Social Security Act (42 U.S.C. 1395cc(j)(3)(A)) is 
amended by inserting ‘‘(or, in the case of a hospice 
program, not more than 2 years)’’ after ‘‘1 year’’. 
(2) MANDATORY APPLICATION OF ENHANCED 
OVERSIGHT
FOR
CERTAIN
HOSPICE
PROGRAMS.— 
Section 1866(j)(3) of the Social Security Act (42 
U.S.C. 1395cc(j)(3)) is amended— 
(A) by redesignating subparagraph (B) as 
subparagraph (C); and 
(B) by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) MANDATORY APPLICATION TO CER-
TAIN HOSPICE PROGRAMS.—The procedures es-
tablished by the Secretary under subparagraph 
(A) shall provide that any hospice program en-
rolling under this title that would, but for appli-
cation of subparagraph (B) or (C) of paragraph 
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(10), have been prohibited from so enrolling be 
subject to the enhanced oversight described in 
such subparagraph for a period of not less than 
30 days.’’. 
(c) INCREASE IN SURVEY FREQUENCY FOR CERTAIN 
HOSPICE PROGRAMS.—Section 1822(a) of the Social Se-
curity Act (42 U.S.C. 1395i–6(a)) is amended— 
(1) in paragraph (1)— 
(A) by inserting ‘‘, with respect to such a 
survey conducted with respect to a hospice pro-
gram that is not included on the list established 
under paragraph (5),’’ after ‘‘local survey agen-
cy, or’’; and 
(B) by inserting ‘‘(or, in the case of a hos-
pice program that is included on the list estab-
lished under paragraph (5), not less frequently 
than once every 18 months)’’ after ‘‘36 
months’’; 
(2) by redesignating paragraph (5) as para-
graph (6); 
(3) by inserting after paragraph (4) the fol-
lowing new paragraph: 
‘‘(5) HOSPICE
PROGRAMS
SUBJECT
TO
IN-
CREASED SURVEY FREQUENCY.— 
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gram on the list established under sub-
paragraph (A)— 
‘‘(I) if claims data submitted by 
such program indicates that such pro-
gram is not providing the full scope of 
hospice care services payable under 
this title; 
‘‘(II) if the Secretary determines 
that such program is an outlier with 
respect to live discharges; or 
‘‘(III) for any other reason deter-
mined appropriate by the Secretary. 
‘‘(C) REMOVAL
FROM
LIST.—The Sec-
retary shall remove a hospice program included 
in the list established under subparagraph 
(A)— 
‘‘(i) if— 
‘‘(I) such program has been sub-
ject to 2 surveys under this subsection 
while included on such list; and 
‘‘(II) neither such survey resulted 
in such program being cited for a de-
ficiency for failure to comply with a 
condition of participation relating to 
quality of care; or 
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‘‘(ii) if such program is placed in the 
special focus program established under 
subsection (b).’’; and 
(4) in paragraph (6), as so redesignated, by 
striking ‘‘each fiscal year (beginning with fiscal year 
2022)’’ and inserting ‘‘each of fiscal years 2022 
through 2025, and of $15,000,000 for fiscal year 
2026 and for each subsequent fiscal year,’’. 
(d) PROHIBITION ON PAYMENT FOR FAILURE TO 
MEET QUALITY DATA REPORTING REQUIREMENTS.— 
Section 1814(i)(5) of the Social Security Act (42 U.S.C. 
1395f(i)(5)) is amended— 
(1) in subparagraph (A)— 
(A) in the header, by striking ‘‘REDUCTION 
IN UPDATE FOR’’; 
(B) in clause (i)— 
(i) in the header, by striking ‘‘IN 
GENERAL’’ and inserting ‘‘FISCAL YEARS 
2014 THROUGH 2026’’; 
(ii) by inserting ‘‘through fiscal year 
2026’’ after ‘‘each subsequent fiscal year’’; 
and 
(iii) by adding at the end the fol-
lowing new sentence: ‘‘The application of 
the preceding sentence may result in the 
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market basket percentage increase under 
paragraph (1)(C)(ii)(VII) or paragraph 
(1)(C)(iii), as applicable, being less than 
0.0 for a fiscal year, and may result in 
payment rates under this subsection for a 
fiscal year being less than such payment 
rates for the preceding fiscal year.’’; and 
(C) by amending clause (ii) to read as fol-
lows: 
‘‘(ii) SUBSEQUENT
FISCAL
YEARS.— 
For purposes of fiscal year 2027 and each 
subsequent fiscal year, no payment may be 
made under this title to a hospice program 
that does not submit data to the Secretary 
in accordance with subparagraph (C) with 
respect to such fiscal year.’’; and 
(2) in subparagraph (B), by striking ‘‘subpara-
graph (A)’’ and inserting ‘‘subparagraph (A)(i)’’. 
(e) ENSURING INDEPENDENCE OF PHYSICIAN CER-
TIFICATIONS
OF
TERMINAL
ILLNESS.—Section 
1814(a)(7)(A)(i) of the Social Security Act (42 U.S.C. 
1395f(a)(7)(A)(i)) is amended— 
(1) in subclause (I), by inserting ‘‘or, with re-
spect to certifications under this clause occurring on 
or after October 1, 2026, in the case such individual 
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fails to designate such an attending physician (or in 
the case such attending physician is employed by the 
hospice program at which such individual will receive 
such care or otherwise has a significant ownership 
interest in, or a significant financial relationship 
with, such program (as determined by the Sec-
retary)), by a physician, physician assistant, or 
nurse practitioner that does not have such a signifi-
cant ownership interest in, or such a significant fi-
nancial relationship with, such program (as deter-
mined by the Secretary)’’ before ‘‘, and’’; and 
(2) in the matter following subclause (II), by 
striking ‘‘physician’s’’ and inserting ‘‘physician’s, 
physician assistant’s, nurse practitioner’s,’’. 
(f) ALLOWING ADDITIONAL PROVIDERS TO CERTIFY 
TERMINAL ILLNESS.— 
(1) IN GENERAL.—Section 1814(a)(7)(A)(i)(I) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395f(a)(7)(A)(i)(I)) is amended by striking ‘‘(which 
for purposes of this subparagraph does not include 
a nurse practitioner or a physician assistant)’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall apply with respect to certifi-
cations of terminal illnesses made on or after Octo-
ber 1, 2026. 
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(g) ALLOWABLE USE OF SUPPORTING MATERIAL IN 
MEDICAL REVIEW OF HOSPICE CARE.—Section 1814(a) 
of the Social Security Act (42 U.S.C. 1395f(a)) is amend-
ed by adding at the end the following new sentence: ‘‘For 
purposes of conducting medical review of hospice care fur-
nished to an individual, in addition to using documenta-
tion in the medical record of such individual’s attending 
physician (as defined in section 1861(dd)) or of the physi-
cian, physician assistant, or nurse practitioner otherwise 
making 
the 
certification 
described 
in 
paragraph 
(7)(A)(i)(I) with respect to such individual, the Secretary 
may use documentation in the medical record of the hos-
pice program furnishing such care as supporting material, 
as determined appropriate by the Secretary.’’. 
(h) PROHIBITION ON CERTAIN CHANGES IN MAJOR-
ITY OWNERSHIP.—With respect to any change in the ma-
jority ownership of a hospice program occurring during 
the 5-year period beginning on the date of the enactment 
of this Act, the Secretary of Health and Human Services 
shall apply section 424.550(b) of title 42, Code of Federal 
Regulations (or a successor regulation) as if the references 
to ‘‘36 months’’ in paragraph (1) of such section were ref-
erences to ‘‘60 months’’. 
(i) ADVANCED NOTICE OF CHANGES IN OWNERSHIP 
OR CONTROL.—Section 1822 of the Social Security Act 
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(42 U.S.C. 1395i–6) is amended by adding at the end the 
following new subsection: 
‘‘(d) ADVANCED NOTICE OF CHANGES IN OWNER-
SHIP OR CONTROL.— 
‘‘(1) IN
GENERAL.—Beginning January 1, 
2027, in the case a change occurs in— 
‘‘(A) the persons with an ownership or 
control 
interest 
(as 
defined 
in 
section 
1124(a)(3)) in the hospice program; 
‘‘(B) the persons who are officers, direc-
tors, agents, or managing employees (as defined 
in section 1126(b)) of the hospice program; 
‘‘(C) the corporation, association, or other 
company responsible for the management of the 
hospice program; or 
‘‘(D) the individual who is the adminis-
trator of the hospice program, or (v) the indi-
vidual who is the medical director of the hospice 
program; 
such program shall provide notice at the time of the 
change (or, in the case such change is with respect 
to a person described in subparagraph (A), at least 
90 days before the effective date of the change) to 
the Secretary, the appropriate State or local survey 
agency, or appropriate approved accreditation agen-
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cy of the change and of the identity of each new per-
son, company, or individual described in the respec-
tive subparagraph. 
‘‘(2) ENFORCEMENT.— 
‘‘(A) IN GENERAL.—In the case that the 
Secretary determines that a hospice program 
has violated paragraph (1), the Secretary 
may— 
‘‘(i) impose a civil monetary penalty 
in an amount not to exceed $1,000,000 per 
violation; and 
‘‘(ii) if determined appropriate by the 
Secretary, terminate such program’s en-
rollment under this title. 
‘‘(B) PROCEDURES.—The provisions of 
section 1128A (other than subsections (a) and 
(b) of such section) shall apply to a civil mone-
tary penalty imposed under subparagraph (A) 
in the same manner as such provisions apply to 
a penalty or proceeding under such section.’’. 
(j) REQUIRED PROVISION OF ADDENDUM OF NON-
COVERED SERVICES.—Section 1812(d)(1) of the Social 
Security Act (42 U.S.C. 1395d(d)(1)) is amended by add-
ing at the end the following new sentence: ‘‘With respect 
to such an election made on or after October 1, 2026, in 
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the case such program determines that there are items 
and services being furnished to such individual that are 
not related to the treatment of the individual’s condition 
with respect to which a diagnosis of terminal illness has 
been made, such election shall include an addendum that 
specifies such items and services and includes such addi-
tional information as may be specified by the Secretary. 
Such program shall provide an updated addendum de-
scribed in the preceding sentence to such individual if, 
while such election is in effect with respect to such indi-
vidual, such program makes any alteration to the adden-
dum provided to such individual at the time of such elec-
tion.’’. 
(k) MEDICAL REVIEW OF HOSPICE OUTLIERS AND 
CARE UNRELATED TO TERMINAL CONDITION.— 
(1) IN GENERAL.— 
(A) 
MEDICAL
REVIEW.—Section 
1814(a)(7) of the Social Security Act (42 
U.S.C. 1395f(a)(7)) is amended— 
(i) in subparagraph (D), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (E), by inserting 
‘‘before the date of the enactment of sub-
paragraph (F),’’ after ‘‘subparagraph,’’; 
and 
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(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) beginning on the date that is 5 years 
after the date of the enactment of this subpara-
graph, in the case of hospice care provided an 
individual for more than 90 days by a hospice 
program with aberrant billing patterns (as de-
termined by the Secretary), the hospice care 
provided to such individual is subject to prepay-
ment medical review (in accordance with proce-
dures established by the Secretary); and’’. 
(B) TECHNICAL EXPERT PANEL.— 
(i) IN
GENERAL.—The Secretary of 
Health and Human Services shall establish 
a technical expert panel for purposes of es-
tablishing standards for identifying a hos-
pice program with a history of aberrant 
billing 
patterns 
under 
section 
1814(a)(7)(F) of the Social Security Act, 
as added by subparagraph (A). In making 
recommendations with respect to such 
standards, such panel shall take into ac-
count the results of prepayment medical 
reviews 
conducted 
under 
section 
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1866(j)(10)(D) of such Act, as added by 
subsection (a). 
(ii) FACA WAIVER.—The provisions 
of chapter 10 of title 5, United States 
Code, shall not apply to the panel estab-
lished under clause (i). 
(2) PREPAYMENT MEDICAL REVIEW REQUIRE-
MENT.—Section 1812(d)(2) of the Social Security 
Act (42 U.S.C. 1395d(d)(2)) is amended by adding 
at the end the following new subparagraph: 
‘‘(E) Notwithstanding any other provision of this 
title, in the case of items and services (other than items 
and services described in the matter following clause 
(ii)(II) of subparagraph (A)) furnished on or after October 
1, 2026, to an individual with an election in effect under 
paragraph (1) by a provider of services or supplier, if such 
provider of services or supplier indicates that such items 
and services are unrelated to the individual’s condition 
with respect to which a diagnosis of terminal illness has 
been made, no payment may be made under this title for 
such items and services before the Secretary has con-
ducted a medical review of such items and services to de-
termine whether such items and services are unrelated to 
such condition. Such review shall include a review of any 
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during such encounter) with such individual to 
gather clinical findings to determine such indi-
vidual’s continue eligibility for hospice care; 
and’’. 
(o) ENSURING MEDICAL DIRECTOR AND PHYSICIAN 
AVAILABILITY.— 
(1) IN GENERAL.—Section 1861(dd) of the So-
cial Security Act (42 U.S.C. 1395x(dd)) is amend-
ed— 
(A) in paragraph (2)— 
(i) in subparagraph (F), by striking 
‘‘and’’ at the end; 
(ii) by redesignating subparagraph 
(G) as subparagraph (I); and 
(iii) by inserting after subparagraph 
(F) the following new subparagraphs: 
‘‘(G) has a medical director responsible for 
the medical component of hospice care provided 
by such program who— 
‘‘(i) is a doctor of medicine or osteop-
athy licensed to practice in the State in 
which such program is located; and 
‘‘(ii) subject to paragraph (6), is not 
the medical director of more than 1 other 
hospice program; 
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ssavage on LAPJG3WLY3PROD with BILLS