IB 
Union Calendar No. 544 
116TH CONGRESS 
2D SESSION 
H. R. 5821 
[Report No. 116–660, Part I] 
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 
DECEMBER 17, 2020 
Additional sponsors: Mr. KILDEE and Mr. RICE of South Carolina 
DECEMBER 17, 2020 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
DECEMBER 17, 2020 
Committee on Energy and Commerce discharged; committed to the Committee 
of the Whole House on the State of the Union and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on February 10, 2020] 
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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. 
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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’’. 
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). 
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‘‘(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 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 subparagraph, information 
respecting any survey or certification made 
with respect to a hospice program by such 
State or body, as applicable. Such informa-
tion shall include any inspection report 
made by such State or body with respect to 
such survey or certification, any enforce-
ment actions taken as a result of such sur-
vey or certification, and any other informa-
tion determined appropriate by the Sec-
retary. 
‘‘(ii) REQUIRED INCLUSION OF SPECI-
FIED
FORM.—With respect to a survey 
under this subsection carried out by a na-
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tional accreditation body described in 
clause (i) on or after October 1, 2021, infor-
mation 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, 
2022, the Secretary shall publish the information 
submitted under subparagraph (A) on the public 
website of the Centers for Medicare & Medicaid 
Services in a manner that is prominent, easily 
accessible, readily understandable, and search-
able. The Secretary shall provide for the timely 
update of such information so published. 
‘‘(3) CONSISTENCY
OF
SURVEYS.—Each State 
and the Secretary shall implement programs to meas-
ure and reduce inconsistency in the application of 
survey results among surveyors. 
‘‘(4) SURVEY TEAMS.— 
‘‘(A) IN GENERAL.—In the case of a survey 
conducted under this subsection on or after Octo-
ber 1, 2021, by more than 1 individual, such 
survey shall be conducted by a multidisciplinary 
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team of professionals (including a registered pro-
fessional 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 
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 com-
prehensive training of State and Federal sur-
veyors, and any surveyor employed by a na-
tional accreditation body described in paragraph 
(2)(A)(i), 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 survey 
team with respect to a survey conducted on or 
after such date unless the individual has success-
fully completed a training and testing program 
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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 Insurance 
Trust Fund under section 1817 to the Centers for 
Medicare & Medicaid Program Management Account, 
of $10,000,000 for each fiscal year (beginning with 
fiscal year 2022) for purposes of carrying out surveys 
under this subsection. Sums so transferred shall re-
main available until expended. Any transfer pursu-
ant to this paragraph shall be in addition to any 
transfer pursuant to section 3(a)(2) of the Improving 
Medicare Post-Acute Care Transformation Act of 
2014. 
‘‘(b) SPECIAL FOCUS PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall conduct 
a special focus program for enforcement of require-
ments for hospice programs that the Secretary has 
identified as having substantially failed to meet ap-
plicable 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 program 
not less than once every 6 months. 
‘‘(c) ENFORCEMENT.— 
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‘‘(1) SITUATIONS INVOLVING IMMEDIATE JEOP-
ARDY.—If the Secretary determines on the basis of a 
standard survey or otherwise that a hospice program 
that is certified for participation under this title is 
no longer in compliance with the requirements speci-
fied in section 1861(dd) and determines that the defi-
ciencies 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 and correct 
the deficiencies through the remedy described in para-
graph (5)(B)(iii) or terminate the certification of the 
program, and may provide, in addition, for 1 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 hospice pro-
gram that is certified for participation under this 
title is no longer in compliance with the requirements 
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 
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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 certification 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 
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 re-
quirements. 
‘‘(4) OPTION TO CONTINUE PAYMENTS FOR NON-
COMPLIANT HOSPICE PROGRAMS.—The Secretary may 
continue payments under this title with respect to a 
hospice program not in compliance with the require-
ments 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 
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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 Secretary 
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-
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 
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‘‘(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 imple-
ment specific procedures with respect to the 
conditions under which each of the remedies 
developed under clause (i) is to be applied, 
including the amount of any fines and the 
severity of each of these remedies. Such pro-
cedures shall be designed so as to minimize 
the time between identification of defi-
ciencies and imposition of these remedies 
and shall provide for the imposition of in-
crementally more severe fines for repeated 
or uncorrected deficiencies. 
‘‘(B) SPECIFIED REMEDIES.—The remedies 
specified in this subparagraph are the following: 
‘‘(i) Civil monetary penalties in an 
amount not to exceed $10,000 for each day 
of noncompliance by a hospice program 
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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 furnished 
by a hospice program on or after the date 
on which the Secretary determines that 
remedies should be imposed pursuant to 
paragraph (2). 
‘‘(iii) The appointment of temporary 
management to oversee the operation of the 
hospice program and to protect and assure 
the health and safety of the individuals 
under the care of the program while im-
provements are made in order to bring the 
program into compliance with all such re-
quirements. 
‘‘(C) PROCEDURES.— 
‘‘(i) CIVIL MONETARY PENALTIES.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the provisions of section 
1128A (other than subsections (a) and 
(b)) shall apply to a civil monetary 
penalty under this subsection in the 
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same manner as such provisions apply 
to a penalty or proceeding under sec-
tion 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 subsection 
may be used to support activities that 
benefit individuals receiving hospice 
care, including education and training 
programs to ensure hospice program 
compliance with the requirements of 
section 1861(dd). 
‘‘(ii) SUSPENSION
OF
PAYMENT.—A 
finding to suspend payment under subpara-
graph (B)(ii) shall terminate when the Sec-
retary finds that the program is in substan-
tial compliance with all such requirements. 
‘‘(iii) TEMPORARY MANAGEMENT.—The 
temporary management under subpara-
graph (B)(iii) shall not be terminated until 
the Secretary has determined that the pro-
gram has the management capability to en-
sure continued compliance with all the re-
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quirements referred to in such subpara-
graph. 
‘‘(D) 
RELATIONSHIP
TO
OTHER
REM-
EDIES.—The remedies developed under subpara-
graph (A) are in addition to sanctions otherwise 
available under State or Federal law and shall 
not be construed as limiting other remedies, in-
cluding any remedy available to an individual 
at common law.’’. 
(2) AVAILABILITY OF HOSPICE ACCREDITATION 
SURVEYS.—Section 1865(b) of the Social Security Act 
(42 U.S.C. 1395bb(b)) is amended by inserting ‘‘or, 
beginning on the date of the enactment of the HOS-
PICE Act, a hospice program’’ after ‘‘home health 
agency’’. 
(3) STATE PROVISION OF HOSPICE PROGRAM IN-
FORMATION.— 
(A) IN GENERAL.—Section 1864(a) of the 
Social Security Act (42 U.S.C. 1395aa(a)) is 
amended in the sixth sentence— 
(i) by inserting ‘‘and hospice pro-
grams’’ after ‘‘information on home health 
agencies’’; 
(ii) by inserting ‘‘or the hospice pro-
gram’’ after ‘‘the home health agency’’; 
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(iii) by inserting ‘‘or the hospice pro-
gram’’ after ‘‘with respect to the agency’’; 
and 
(iv) by inserting ‘‘and hospice pro-
grams’’ after ‘‘with respect to home health 
agencies’’. 
(B) EFFECTIVE
DATE.—The amendments 
made by subparagraph (A) shall apply with re-
spect to agreements entered into on or after, or 
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 PROGRAM.— 
Section 1861(dd)(4) of the Social Security 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 FAILURE 
TO MEET QUALITY DATA REPORTING REQUIREMENTS.— 
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 
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fiscal year 2023 and each subsequent fiscal year, 4 percent-
age points)’’ before the period. 
(c) REPORT.—Not later than 36 months after the date 
of the enactment of this Act, the Comptroller General of the 
United States shall submit to the Committee on Ways and 
Means of the House of Representatives 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 frequency of application of remedies specified 
in section 1822(c)(5)(B) of the Social Security Act (as 
added by such subsection), on access to, and quality of, care 
furnished by hospice programs under part A of title XVIII 
of the Social Security Act (42 U.S.C. 1395c et seq.). 
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Union Calendar No. 544 
116TH CONGRESS 
2D SESSION 
H. R. 5821 
[Report No. 116–660, Part I] 
A BILL 
To amend title XVIII of the Social Security Act to 
establish hospice program survey and enforce-
ment procedures under the Medicare program, 
and for other purposes. 
DECEMBER 17, 2020 
Reported from the Committee on Ways and Means with 
an amendment 
DECEMBER 17, 2020 
Committee on Energy and Commerce discharged; com-
mitted to the Committee of the Whole House on the 
State of the Union and ordered to be printed 
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