Hospice Evaluation and Legitimate Payment Act of 2013

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Hospice Evaluation and Legitimate 
Payment Act of 2013''.

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 
                        practitioner, clinical nurse specialist, or 
                        physician assistant (as those terms are defined 
                        in section 1861(aa)(5)), or other health 
                        professional (as designated by the Secretary), 
                        has a face-to-face encounter with the 
                        individual to determine continued eligibility 
                        of the individual for hospice care prior to the 
                        first 60-day period and each subsequent 
                        recertification under subparagraph (A)(ii) (or, 
                        in the case where a hospice program newly 
                        admits an individual who would be entering 
                        their first 60-day period or a subsequent 
                        hospice benefit period or where exceptional 
                        circumstances, as defined by the Secretary, may 
                        prevent a face-to-face encounter prior to the 
                        beginning of the hospice benefit period, not 
                        later than 7 calendar days after the 
                        individual's election under section 1812(d)(1) 
                        with respect to the hospice program) and 
                        attests that such visit took place (in 
                        accordance with procedures established by the 
                        Secretary); and''.
    (b) Effective Date.--The amendment made by subsection (a) takes 
effect on January 1, 2014, and applies to hospice care furnished on or 
after such date.

SEC. 3. RESTORING AND PROTECTING THE MEDICARE HOSPICE BENEFIT.

    (a) In General.--Section 1814(i) of the Social Security 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 
                                striking ``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 notice of 
                                the proposed regulation in the Federal 
                                Register and a period for public 
                                comment in accordance with section 
                                1871(b)(1),''; and
                                    (II) in the second sentence, by 
                                inserting `` and shall take into 
                                account 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) unless the Secretary 
                determines that the demonstration program under 
                subparagraph (F) demonstrated that such revisions would 
                adversely 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 demonstration program.--
                    ``(i) Establishment of demonstration program.--
                            ``(I) In general.--Before implementing any 
                        revisions to the methodology for determining 
                        the payment rates for routine home care and 
                        other services included in hospice care under 
                        subparagraph (D), 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 demonstration program.
                            ``(IV) Representative participation.--
                        Hospice programs selected under subclause (III) 
                        to participate in the demonstration program 
                        shall include a representative cross-section of 
                        hospice programs throughout the United States, 
                        including programs located in urban and rural 
                        areas.
                    ``(ii) Evaluation and report.--
                            ``(I) Evaluation.--The Secretary shall 
                        conduct an evaluation of the demonstration 
                        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 revisions on hospice care 
                        providers, including the impact, if any, on the 
                        ability of hospice programs to furnish quality 
                        care to beneficiaries under this title.
                            ``(II) Report.--Not later than 2 years 
                        after the completion of the demonstration 
                        program, the Secretary shall submit to Congress 
                        a report containing the results of the 
                        evaluation conducted under subclause (I), 
                        together with recommendations for such 
                        legislation and administrative action as the 
                        Secretary determines appropriate.
                    ``(iii) Budget neutrality.--With respect to the 2-
                year period of the demonstration program, the Secretary 
                shall ensure that revisions in payment implemented as 
                part of the demonstration program shall result in the 
                same estimated amount of aggregate payments under this 
                title for hospice care for the programs participating 
                in the demonstration as would have been made if the 
                hospice programs had not participated 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 frequently than once every 36 months beginning 6 
months after the date of the enactment of this subparagraph.''.

Summary: Hospice Evaluation and Legitimate Payment Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act with respect to the face-to-face encounter framework in hospice care. Allows a clinical nurse specialist, physician assistant, or other health professional (in addition to a hospice physician or a nurse practitioner, as under current law) to conduct the face-to-face encounter with the individual to determine continued eligibility for hospice care before the first 60-day (currently 180-day) recertification period and each subsequent recertification. Directs the Secretary of Health and Human Services (HHS) to establish a Medicare Hospital Payment Reform demonstration program to test any revisions to the methodology for determining payment rates for routine home care and other hospice care services. Sets at every three years the frequency of surveys of certified hospice programs.