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.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 1053 Introduced in Senate (IS)]
113th CONGRESS
1st Session
S. 1053
To amend title XVIII of the Social Security Act to strengthen and
protect Medicare hospice programs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 23, 2013
Mr. Wyden (for himself and Mr. Roberts) 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 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 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.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S3852)
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