Hospice Evaluation and Legitimate Payment Act - 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 an individual to determine continued eligibility for hospice care before the first 60-day (currently, 180-day) recertification period and each subsequent recertification period.
Requires the Secretary of Health and Human Services (HHS) to establish a Medicare Hospice 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 program entities.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3506 Introduced in House (IH)]
112th CONGRESS
1st Session
H. R. 3506
To strengthen and protect Medicare hospice programs.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 22, 2011
Mr. Reed (for himself, Mr. Paulsen, and Mr. Thompson of California)
introduced 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
_______________________________________________________________________
A BILL
To strengthen and protect Medicare hospice programs.
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 Evaluation and Legitimate
Payment Act''.
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, a nurse
practitioner, a clinical nurse specialist, or a
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 the date of enactment of this Act 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 subparagraph (1)(C)--
(A) in clause (ii)--
(i) in the matter preceding subclause (I),
by striking ``(6)(D)'' and inserting
``(6)(E)''; and
(ii) in subclause (VII), by striking
``(6)(D)'' and inserting ``(6)(E)''; and
(B) in clause (iii), by moving such clause 6 ems to
the left and striking ``(6)(D)'' and inserting
``(6)(E)''; and
(2) in paragraph (6)--
(A) in subparagraph (A), by striking ``subparagraph
(D)'' and inserting ``subparagraph (E)'';
(B) by redesignating subparagraphs (D) and (E) as
subparagraphs (E) and (F), respectively, and inserting
after subparagraph (C) the following new subparagraph:
``(D) Hospice payment reform demonstration program.--
``(i) Establishment of demonstration program.--
``(I) In general.--Prior to implementing
any revisions to the methodology for
determining the payment rates for routine home
care and other services included in hospice
care under subparagraph (E), the Secretary
shall establish a Medicare Hospice Payment
Reform 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.--The Secretary shall select
not more than 15 hospice programs at which the
demonstration program under this subparagraph
shall be conducted.
``(IV) Representative participation.--
Hospice programs selected under subclause (III)
to participate in the demonstration program
shall include a representative cross-section of
such programs throughout the United States,
including programs located in urban and rural
areas.
``(V) Voluntary participation.--Hospice
program participation in the demonstration
program shall be on a voluntary basis.
``(ii) Evaluation and report.--
``(I) Evaluation.--The Secretary shall
conduct an evaluation of the demonstration
program under this subparagraph. 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 services 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 1 year 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 under this
subparagraph, the Secretary shall ensure that the
estimated amount of aggregate payments under this title
to each hospice program participating in the
demonstration program for such period shall not be more
than 5 percent higher or 5 percent lower than the
estimated amount of aggregate payments that would have
been made under this title to each such hospice program
during such period had they not participated in the
demonstration program under this subparagraph.'';
(C) in subparagraph (E), as redesignated by
subparagraph (B)--
(i) in clause (i)--
(I) in the first sentence, by
striking ``October 1, 2013, the
Secretary shall, by regulation'' and
inserting ``subject to clause (iii),
the later of 2 years after the
demonstration program under
subparagraph (D) is completed or
October 1, 2017, the Secretary shall,
by regulation, preceded by 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 (D)(ii)''
before the period; and
(ii) by adding at the end the following new
clause:
``(iii) In no case may the Secretary implement any
revisions in payment pursuant to clause (i) unless the
Secretary determines that the demonstration program
under subparagraph (D) demonstrated that such revisions
would not adversely affect access to quality hospice
care by beneficiaries under this title.''; and
(D) in subparagraph (F), as redesignated by
subparagraph (B), by striking ``subparagraph (D)'' and
inserting ``subparagraph (E)''.
SEC. 4. HOSPICE SURVEY REQUIREMENT.
(a) In General.--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 seeking certification as a hospice program shall
be subject to an initial survey by an appropriate State or local survey
agency, or an approved accreditation agency, as determined by the
Secretary, not later than 6 months after beginning operations, and any
entity which is certified as a hospice program shall be subject to a
standard survey not less frequently than every 36 months.''.
(b) Effective Date.--The amendment made by subsection (a) takes
effect on the date that is 180 days after the date of enactment of this
Act and applies to hospice programs on or after such date.
<all>
Introduced in House
Introduced in House
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.
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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line