I 
114TH CONGRESS 
1ST SESSION H. R. 3037 
To amend title XVIII of the Social Security Act to improve access to hospice 
care under the Medicare program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 13, 2015 
Mr. REED (for himself and Mr. THOMPSON of California) introduced the 
following bill; which was referred to the Committee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to improve 
access to hospice care 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 cited as the ‘‘Hospice Care Access Im-
provement Act of 2015’’. 
SEC. 2. HOSPICE PAYMENT REFORM DEMONSTRATION 
PROGRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this Act referred to as the ‘‘Sec-
retary’’) shall conduct a demonstration program for a 1- 
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year period during fiscal year 2016 to test the proposed 
hospice payment methodology revisions. 
(b) PROPOSED HOSPICE PAYMENT METHODOLOGY 
REVISIONS DEFINED.—In this section, the term ‘‘pro-
posed hospice payment methodology revisions’’ means re-
visions to the methodology for determining hospice pay-
ment rates under section 1814(i)(6)(D) of the Social Secu-
rity Act (42 U.S.C. 1395f(i)(6)(D)) contained in the Fis-
cal Year 2016 Hospice Wage Index and Payment Rate 
Update and Hospice Quality Reporting Requirements as 
published by the Centers for Medicare & Medicaid Services 
on May 5, 2015 (80 Fed. Reg. 25831 et seq.). 
(c) SCOPE.—The Secretary shall select one Medicare 
administrative contractor to conduct the demonstration 
program. Such contractor shall conduct the demonstration 
program with respect to all hospice programs under that 
contractor’s jurisdiction. 
(d) EVALUATION.—The Secretary shall conduct an 
evaluation of the demonstration program, which shall in-
clude an analysis of the impact of the proposed hospice 
payment methodology revisions— 
(1) on the quality of patient care and the ability 
of hospice programs to provide such care; and 
(2) on access to hospice care for beneficiaries. 
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(e) REPORT.—Not later than March 31, 2017, the 
Secretary shall submit to Congress a report on the dem-
onstration program. The report shall include— 
(1) the results of the evaluation under sub-
section (d); and 
(2) recommendations for such legislation and 
administrative action as the Secretary determines 
appropriate. 
(f) IMPLEMENTATION OF HOSPICE PAYMENT METH-
ODOLOGY REVISIONS.— 
(1) PROHIBITION ON IMPLEMENTATION OF RE-
VISIONS FOR FISCAL YEARS 2016 AND 2017.—No revi-
sions to the hospice payment methodology shall be 
made under section 1814(i)(6)(D) of the Social Se-
curity Act (42 U.S.C. 1395f(i)(6)(D)) for fiscal 
years 2016 and 2017, except for purposes of the 
demonstration program required to be conducted 
under subsection (a). 
(2) IMPLEMENTATION OF REVISIONS FOR FIS-
CAL YEAR 2018.—After taking into account the re-
sults of the evaluation of the demonstration program 
and after making any necessary revisions, the Sec-
retary shall implement the proposed hospice pay-
ment methodology revisions beginning with fiscal 
year 2018. 
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SEC. 3. HOSPICE PROGRAM INTEGRITY. 
(a) MEDICAL REVIEW FOR CERTAIN HOSPICE PRO-
GRAMS.—Section 1814(i) of the Social Security Act (42 
U.S.C. 1395f(i)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(8) MEDICAL REVIEW FOR CERTAIN HOS-
PICE PROGRAMS.— 
‘‘(A) IN
GENERAL.—The Secretary 
shall implement a process for the medical 
review of hospice care furnished by a hos-
pice program identified under subpara-
graph (B). 
‘‘(B) IDENTIFICATION
OF
HOSPICE 
PROGRAMS
FOR
MEDICAL
REVIEW.—The 
Secretary shall identify hospice programs 
the patients of which will be subject to 
medical review under subparagraph (A). In 
identifying such programs, the Secretary 
shall consider multiple factors in compari-
son with other similarly situated hospice 
programs, such as— 
‘‘(i) the percentage of patients 
who were discharged after receiving 
hospice care for a period of 120 to 
180 days and who were alive upon 
such discharge; 
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‘‘(ii) the percentage of patients 
who are receiving hospice care from 
the program at the end of life who re-
ceive no skilled hospice care visits in 
the last week of life; and 
‘‘(iii) the level of per-patient ex-
penditures under this title for patients 
of the hospice program excluding ex-
penditures for hospice care. 
‘‘(C) LIMITATION
ON
LIABILITY
OF 
BENEFICIARY
WHERE
MEDICARE
CLAIMS 
ARE DISALLOWED.—The provisions of this 
title relating to the limitation on liability of 
a beneficiary where Medicare claims are 
disallowed shall apply with respect to this 
paragraph in the same manner as they 
apply to subsection (a)(7)(E).’’. 
(b) DEVELOPING INTERVENTIONS TO REDUCE HOS-
PITAL ADMISSIONS.—The Secretary shall develop and 
publish guidance, where appropriate and in consultation 
with interested parties, for hospice programs to develop 
interventions to reduce hospital admissions and visits to 
hospital emergency departments by patients of such hos-
pice programs. 
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(c) EXPANDING WHO MAY PERFORM PRE-HOSPICE 
EVALUATION AND COUNSELING SERVICES.— 
(1) IN GENERAL.—Section 1812(a)(5) of the 
Social Security Act (42 U.S.C. 1395d(a)(5)) is 
amended by inserting after ‘‘hospice program’’ the 
following: ‘‘, or services that are furnished by a reg-
istered nurse who is an employee of a hospice pro-
gram in consultation, if necessary, with other mem-
bers of the interdisciplinary group described in sec-
tion 1861(dd)(2)(B),’’. 
(2) EVALUATION AND REPORT.— 
(A) EVALUATION.—The Secretary shall 
evaluate the impact of the amendment made by 
paragraph (1). Such evaluation shall include an 
evaluation of the impact of such amendment on 
hospital admission rates, hospice care utiliza-
tion, and length of stay in hospice programs for 
patients 
receiving 
services 
under 
section 
1812(a)(5) of the Social Security Act (42 
U.S.C. 1395d(a)(5)). 
(B) REPORT.—The Secretary shall submit 
a report to Congress containing the results of 
the evaluation under subparagraph (A). 
(d) EXPANDING HOSPICE CARE ACCESS FOR RESI-
DENTS USING SKILLED NURSING FACILITIES.— 
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(1) MEDICARE AND SKILLED NURSING FACILI-
TIES.—Section 1819 of the Social Security Act (42 
U.S.C. 1395i–3) is amended— 
(A) in subsection (b)(4), by adding at the 
end the following new subparagraph: 
‘‘(D) HOSPICE PROGRAM CONTRACTING.— 
In the case of a facility that contracts with a 
hospice program for hospice care for its resi-
dents, such facility shall make a good faith ef-
fort to enter into a contract with more than one 
hospice program participating under this title 
that provides services in the area served by the 
facility, if more than one hospice program is 
available to serve such residents.’’; and 
(B) in subsection (c)(1)(A)(i), by inserting 
after ‘‘well-being,’’ the following: ‘‘to be fully in-
formed, in a form and manner specified by the 
Secretary, of any financial interest, as specified 
by the Secretary, the skilled nursing facility has 
in any hospice program to which a resident is 
referred,’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to skilled nursing fa-
cilities in operation 1 year after the date of the en-
actment of this Act. 
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(e) HOSPITAL DISCHARGE PLANNING PROVISIONS 
RELATING TO HOSPICE CARE.— 
(1) IN GENERAL.—Section 1861(ee)(2) of the 
Social Security Act (42 U.S.C. 1395x(ee)(2)) is 
amended— 
(A) in subparagraph (D), by striking the 
period at the end and inserting ‘‘and, in the 
case of individuals likely to need hospice care, 
the availability of such care through hospice 
programs that participate in the program under 
this title and that serve the area in which the 
patient resides and that request to be listed by 
the hospital as available.’’; and 
(B) in subparagraph (H)(i), by inserting 
‘‘or hospice care’’ after ‘‘home health services’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to discharges occur-
ring on or after 90 days after the date of the enact-
ment of this Act. 
Æ 
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