Title: Hospice Care Improvement Act of 2019
Policy area: Health

Summary:
Hospice Care Improvement Act of 2019
This bill establishes survey requirements for, and enforcement mechanisms against, certified hospice programs under Medicare.
Specifically, certified programs must undergo periodic surveys by a state, local, or approved accreditation agency, as specified; the Centers for Medicare & Medicaid Services (CMS) must provide joint training for surveyors and programs, and must publish information relating to survey results on the Hospice Compare website. Surveyors must provide programs with educational materials to help them correct any found deficiencies. If the CMS finds that a program does not meet applicable standards, the CMS may impose intermediate sanctions, including suspended Medicare payments, temporary management, and additional training; such programs must also undergo more frequent surveys until they are found to be in compliance.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2807 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  1st Session
                                S. 2807

To amend title XVIII of the Social Security Act to improve the quality 
   of care furnished by hospice programs under the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            November 7, 2019

Mr. Portman (for himself and Mr. Cardin) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to improve the quality 
   of care furnished by hospice programs under the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Hospice Care Improvement Act of 
2019''.

SEC. 2. IMPROVING QUALITY REPORTING AND TRANSPARENCY FOR HOSPICE CARE.

    (a) Increasing Reported Hospice Data.--
            (1) Availability of hospice accreditation surveys.--
                    (A) In general.--Section 1865(b) of the Social 
                Security Act (42 U.S.C. 1395bb(b)) is amended by 
                inserting ``or a hospice program'' after ``home health 
                agency''.
                    (B) Effective date.--The amendment made by 
                subparagraph (A) shall apply to surveys conducted on or 
                after the date of the enactment of this Act.
            (2) Inclusion of reports by state and local survey agencies 
        and approved accreditation agencies on hospice compare.--
        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:
    ``(D)(i) Not later than 6 months after the date of the enactment of 
this subparagraph, the Secretary, subject to clauses (ii) and (iii), 
shall include on what is commonly referred to as the Hospice Compare 
internet website (or any successor website) information from reports by 
State and local survey agencies and approved accreditation agencies 
described in subparagraph (C)(i).
    ``(ii) The information required to be included under clause (i) 
shall be presented in a manner that is prominent, updated and removed 
on a timely basis, targeted to deficiencies related to quality of care, 
easily accessible, readily understandable to consumers of hospice 
services, and searchable. Such information shall also include a link to 
the reports.
    ``(iii) In determining the information required to be included 
under clause (i) and the format of such information under (ii), the 
Secretary shall consult with--
            ``(I) employees of hospice programs and their 
        representatives;
            ``(II) provider stakeholder groups;
            ``(III) accreditation organizations;
            ``(IV) State and local survey agencies;
            ``(V) caregivers of current or former hospice patients; and
            ``(VI) any other representatives of programs or groups the 
        Secretary determines appropriate.''.
            (3) Increased deficiency data reporting by approved hospice 
        accreditation agencies.--Not later than 6 months after the date 
        of the enactment of this Act, the Secretary of Health and Human 
        Services shall expand the information that approved 
        accreditation agencies (as described in section 
        1861(dd)(4)(C)(i) of the Social Security Act (42 U.S.C. 
        1395x(dd)(4)(C)(i))), as amended by subsection (b), are 
        required to report with respect to deficiencies by a hospice 
        program to be comparable to the information that State and 
        local survey agencies (as described in such section) report 
        with respect to such deficiencies.
    (b) Improving the Hospice Survey Process.--Section 1861(dd)(4)(C) 
of the Social Security Act (42 U.S.C. 1395x(dd)(4)(C)) is amended to 
read as follows:
    ``(C)(i) Subject to the succeeding provisions of this subparagraph, 
beginning 6 months after the date of enactment of the Improving 
Medicare Post-Acute Care Transformation Act of 2014, 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.
    ``(ii) Any entity that is first certified as a hospice program 
after the date of enactment of the Hospice Care Improvement Act of 2019 
shall be subject to a standard survey described in clause (i) within 12 
months of such certification. After such standard survey, such entity 
shall be subject to standard surveys in accordance with clause (i).
    ``(iii) Any entity that is subject to an intermediate sanction 
under paragraph (6) shall be subject to a standard survey described in 
clause (i) not less than once every 12 months until such time that the 
entity is found by the State or local survey agency or approved 
accreditation agency to be in compliance with the requirements under 
this title for a period of 24 months.
    ``(iv) If a State and local survey agency or an approved 
accreditation agency identifies a deficiency of an entity as part of a 
standard survey conducted pursuant to this subparagraph, the agency 
shall notify the entity of the finding and provide the entity with (or 
provide access to) educational information on how to address the 
deficiency and prevent future deficiencies. Such educational 
information (or access to such information) shall be provided to the 
entity upon the completion of the site visit performed as part of the 
survey. Such educational information shall be standardized for purposes 
of both educating hospice programs and surveyors from local survey 
agencies and approved accreditation agencies.
    ``(v) The Secretary shall establish a process for joint training 
and education of State and local survey agencies, approved 
accreditation agencies, and hospice programs on a regular basis as 
changes to regulations, guidelines, and policies governing hospice 
program operations are implemented and used in standard surveys of 
participating hospice programs.''.
    (c) Annual Report of Deficiencies.--
            (1) Study.--The Secretary of Health and Human Services (in 
        this section referred to as the ``Secretary'') shall conduct an 
        annual study on deficiencies by a hospice programs under the 
        Medicare program. Such study shall include an analysis of ways 
        to address such deficiencies.
            (2) Report.--Not later than January 1, 2021, the Secretary 
        shall submit to Congress a report on the study conducted under 
        paragraph (1), together with recommendations for such 
        legislation and administrative action as the Secretary 
        determines appropriate.

SEC. 3. INCREASING COMPLIANCE OF QUALITY STANDARDS FOR HOSPICE CARE.

    (a) Increasing Payment Reductions for Failing To Report Quality 
Measures.--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 fiscal year 
2021 and subsequent fiscal years, 4 percentage points'' before the 
period at the end.
    (b) Authority To Impose Intermediate Sanctions.--Section 1861(dd) 
of the Social Security Act (42 U.S.C. 1395x(dd)) is amended by adding 
at the end the following paragraph:
    ``(6) Beginning 1 year after the date of enactment of the Hospice 
Care Improvement Act of 2019, if the Secretary determines based on the 
results of a survey that a hospice program no longer meets the 
applicable requirements of this Act, the Secretary--
            ``(A) shall issue guidance on ways to determine the 
        mechanisms for imposing a range of intermediate sanctions on 
        hospice programs; and
            ``(B) may impose an intermediate sanction on the hospice 
        program, including but not limited to, the following:
                    ``(i) Suspension of all or part of the payments to 
                which a hospice program would otherwise be entitled 
                under this title for all new admissions on or after the 
                date on which the Secretary determines that 
                intermediate sanctions should be imposed.
                    ``(ii) The appointment of temporary management to 
                oversee the operation of the hospice program and to 
                protect and assure the health and safety of individuals 
                under the care of the hospice program while 
                improvements are made in order to bring the hospice 
                program into compliance with all the requirements 
                specified in this section.
                    ``(iii) Implementation of a directed plan of 
                correction under which the Secretary or the temporary 
                manager may direct the hospice program to take specific 
                corrective action to achieve specific outcomes within 
                specific timeframes.
                    ``(iv) If the Secretary determines that education 
                is likely to correct the deficiencies, imposition of a 
                requirement that all hospice program staff attend in-
                service training programs deemed acceptable by the 
                Secretary.''.
                                 <all>