I 
113TH CONGRESS 
1ST SESSION H. R. 2302 
To amend title XVIII of the Social Security Act to strengthen and protect 
Medicare hospice programs. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 6, 2013 
Mr. REED (for himself, Mr. THOMPSON of California, Mr. PAULSEN, Mr. 
BLUMENAUER, Mr. MICHAUD, Mr. CONNOLLY, Mr. YOUNG of Florida, 
Mr. KING of Iowa, and Mr. GRIJALVA) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently 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 
strengthen and protect Medicare hospice programs. 
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 Evaluation 
and Legitimate Payment Act of 2013’’. 
VerDate Mar 15 2010 
21:34 Jun 08, 2013
Jkt 029200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H2302.IH
H2302
mstockstill on DSK4VPTVN1PROD with BILLS
SEC. 2. ENSURING TIMELY ACCESS TO HOSPICE CARE. 
(a) IN GENERAL.—Section 1814(a)(7)(D)(i) of the 
Social Security Act (42 U.S.C. 1395f(a)(7)(D)(i)) is 
amended to read as follows: 
‘‘(i) a hospice physician, nurse practi-
tioner, clinical nurse specialist, or physi-
cian assistant (as those terms are defined 
in section 1861(aa)(5)), or other health 
professional (as designated by the Sec-
retary), has a face-to-face encounter with 
the individual to determine continued eligi-
bility of the individual for hospice care 
prior to the first 60-day period and each 
subsequent recertification under subpara-
graph (A)(ii) (or, in the case where a hos-
pice program newly admits an individual 
who would be entering their first 60-day 
period or a subsequent hospice benefit pe-
riod or where exceptional circumstances, as 
defined by the Secretary, may prevent a 
face-to-face encounter prior to the begin-
ning of the hospice benefit period, not later 
than 7 calendar days after the individual’s 
election under section 1812(d)(1) with re-
spect to the hospice program) and attests 
that such visit took place (in accordance 
VerDate Mar 15 2010 
21:34 Jun 08, 2013
Jkt 029200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2302.IH
H2302
mstockstill on DSK4VPTVN1PROD with BILLS
with procedures established by the Sec-
retary); and’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) takes effect on January 1, 2014, and ap-
plies to hospice care furnished on or after such date. 
SEC. 3. RESTORING AND PROTECTING THE MEDICARE HOS-
PICE BENEFIT. 
(a) IN GENERAL.—Section 1814(i) of the Social Se-
curity Act (42 U.S.C. 1395f(i)) is amended— 
(1) in paragraph (6)— 
(A) in subparagraph (D)— 
(i) in clause (i)— 
(I) in the first sentence, by strik-
ing ‘‘not earlier than October 1, 2013, 
the Secretary shall, by regulation,’’ 
and inserting ‘‘subject to clause (iii), 
not earlier than the later of 2 years 
after 
the 
demonstration 
program 
under subparagraph (F) is completed 
or October 1, 2017, the Secretary 
shall, by regulation, preceded by a no-
tice of the proposed regulation in the 
Federal Register and a period for 
public comment in accordance with 
section 1871(b)(1),’’; and 
VerDate Mar 15 2010 
21:34 Jun 08, 2013
Jkt 029200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2302.IH
H2302
mstockstill on DSK4VPTVN1PROD with BILLS
(II) in the second sentence, by 
inserting ‘‘ and shall take into ac-
count the results of the evaluation 
conducted 
under 
subparagraph 
(F)(ii)’’ before the period; and 
(ii) by adding at the end the following 
new clause: 
‘‘(iii) The Secretary shall implement the 
revisions in payment pursuant to clause (i) un-
less the Secretary determines that the dem-
onstration program under subparagraph (F) 
demonstrated that such revisions would ad-
versely affect access to quality hospice care by 
beneficiaries under this title.’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) HOSPICE PAYMENT REFORM DEMONSTRA-
TION PROGRAM.— 
‘‘(i) ESTABLISHMENT OF DEMONSTRATION 
PROGRAM.— 
‘‘(I) IN
GENERAL.—Before imple-
menting any revisions to the methodology 
for determining the payment rates for rou-
tine home care and other services included 
in hospice care under subparagraph (D), 
VerDate Mar 15 2010 
21:34 Jun 08, 2013
Jkt 029200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2302.IH
H2302
mstockstill on DSK4VPTVN1PROD with BILLS
the Secretary shall establish a Medicare 
Hospice Payment Reform demonstration 
program (in this subparagraph referred to 
as the ‘demonstration program’) to test 
such proposed revisions. 
‘‘(II) DURATION.—The demonstration 
program shall be conducted for a 2-year 
period beginning on or after October 1, 
2013. 
‘‘(III) SCOPE.—Any certified hospice 
program may apply to participate in the 
demonstration program and the Secretary 
shall select not more than 15 such hospice 
programs to participate in the demonstra-
tion program. 
‘‘(IV) REPRESENTATIVE
PARTICIPA-
TION.—Hospice programs selected under 
subclause (III) to participate in the dem-
onstration program shall include a rep-
resentative cross-section of hospice pro-
grams throughout the United States, in-
cluding programs located in urban and 
rural areas. 
‘‘(ii) EVALUATION AND REPORT.— 
VerDate Mar 15 2010 
21:34 Jun 08, 2013
Jkt 029200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2302.IH
H2302
mstockstill on DSK4VPTVN1PROD with BILLS
‘‘(I) 
EVALUATION.—The 
Secretary 
shall conduct an evaluation of the dem-
onstration program. Such evaluation shall 
include an analysis of whether the use of 
the revised payment methodology under 
the demonstration program has improved 
the quality of patient care and access to 
hospice care for beneficiaries under this 
title and the impact of such payment revi-
sions on hospice care providers, including 
the impact, if any, on the ability of hospice 
programs to furnish quality care to bene-
ficiaries under this title. 
‘‘(II) REPORT.—Not later than 2 
years after the completion of the dem-
onstration program, the Secretary shall 
submit to Congress a report containing the 
results of the evaluation conducted under 
subclause (I), together with recommenda-
tions for such legislation and administra-
tive action as the Secretary determines ap-
propriate. 
‘‘(iii) BUDGET NEUTRALITY.—With respect 
to the 2-year period of the demonstration pro-
gram, the Secretary shall ensure that revisions 
VerDate Mar 15 2010 
21:34 Jun 08, 2013
Jkt 029200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2302.IH
H2302
mstockstill on DSK4VPTVN1PROD with BILLS
in payment implemented as part of the dem-
onstration program shall result in the same es-
timated amount of aggregate payments under 
this title for hospice care for the programs par-
ticipating in the demonstration as would have 
been made if the hospice programs had not par-
ticipated in the demonstration program.’’. 
SEC. 4. HOSPICE SURVEY REQUIREMENT. 
Section 1861(dd)(4) of the Social Security Act (42 
U.S.C. 1395x(dd)(4)) is amended by adding at the end 
the following new subparagraph: 
‘‘(C) Any entity that is certified as a hospice program 
shall be subject to a standard survey by an appropriate 
State or local survey agency, or an approved accreditation 
agency, as determined by the Secretary, not less fre-
quently than once every 36 months beginning 6 months 
after the date of the enactment of this subparagraph.’’. 
Æ 
VerDate Mar 15 2010 
21:34 Jun 08, 2013
Jkt 029200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6301
E:\BILLS\H2302.IH
H2302
mstockstill on DSK4VPTVN1PROD with BILLS