HOSPICE Act

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] VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 5821 RH 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. VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6652 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 5821 RH Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Helping Our Senior 4 Population in Comfort Environments Act’’ or the ‘‘HOS- 5 PICE Act’’. 6 SEC. 2. ESTABLISHING HOSPICE PROGRAM SURVEY AND 7 ENFORCEMENT PROCEDURES UNDER THE 8 MEDICARE PROGRAM. 9 (a) SURVEY AND ENFORCEMENT PROCEDURES.— 10 (1) IN GENERAL.—Part A of title XVIII of the 11 Social Security Act (42 U.S.C. 1395c et seq.) is 12 amended by adding at the end the following new sec- 13 tion: 14 ‘‘SEC. 1822. HOSPICE PROGRAM SURVEY AND ENFORCE- 15 MENT PROCEDURES. 16 ‘‘(a) SURVEYS.— 17 ‘‘(1) FREQUENCY.—Any entity that is certified 18 as a hospice program shall be subject to a standard 19 survey by an appropriate State or local survey agen- 20 cy, or an approved accreditation agency, as deter- 21 mined by the Secretary, not less frequently than once 22 every 36 months (and not less frequently than once 23 every 24 months beginning October 1, 2021). 24 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 5821 RH ‘‘(2) PUBLIC TRANSPARENCY OF SURVEY AND 1 CERTIFICATION INFORMATION.— 2 ‘‘(A) SUBMISSION OF INFORMATION TO THE 3 SECRETARY.— 4 ‘‘(i) IN GENERAL.—Each State, and 5 each national accreditation body with re- 6 spect to which the Secretary has made a 7 finding under section 1865(a) respecting the 8 accreditation of a hospice program by such 9 body, shall submit, in a form and manner, 10 and at a time, specified by the Secretary for 11 purposes of this subparagraph, information 12 respecting any survey or certification made 13 with respect to a hospice program by such 14 State or body, as applicable. Such informa- 15 tion shall include any inspection report 16 made by such State or body with respect to 17 such survey or certification, any enforce- 18 ment actions taken as a result of such sur- 19 vey or certification, and any other informa- 20 tion determined appropriate by the Sec- 21 retary. 22 ‘‘(ii) REQUIRED INCLUSION OF SPECI- 23 FIED FORM.—With respect to a survey 24 under this subsection carried out by a na- 25 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 5821 RH tional accreditation body described in 1 clause (i) on or after October 1, 2021, infor- 2 mation described in such clause shall in- 3 clude Form 2567 (or a successor form), 4 along with such additional information de- 5 termined appropriate by such body. 6 ‘‘(B) PUBLIC DISCLOSURE OF INFORMA- 7 TION.—Beginning not later than October 1, 8 2022, the Secretary shall publish the information 9 submitted under subparagraph (A) on the public 10 website of the Centers for Medicare & Medicaid 11 Services in a manner that is prominent, easily 12 accessible, readily understandable, and search- 13 able. The Secretary shall provide for the timely 14 update of such information so published. 15 ‘‘(3) CONSISTENCY OF SURVEYS.—Each State 16 and the Secretary shall implement programs to meas- 17 ure and reduce inconsistency in the application of 18 survey results among surveyors. 19 ‘‘(4) SURVEY TEAMS.— 20 ‘‘(A) IN GENERAL.—In the case of a survey 21 conducted under this subsection on or after Octo- 22 ber 1, 2021, by more than 1 individual, such 23 survey shall be conducted by a multidisciplinary 24 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 5821 RH team of professionals (including a registered pro- 1 fessional nurse). 2 ‘‘(B) PROHIBITION OF CONFLICTS OF IN- 3 TEREST.—Beginning October 1, 2021, a State 4 may not use as a member of a survey team 5 under this subsection an individual who is serv- 6 ing (or has served within the previous 2 years) 7 as a member of the staff of, or as a consultant 8 to, the program surveyed respecting compliance 9 with the requirements of section 1861(dd) or who 10 has a personal or familial financial interest in 11 the program being surveyed. 12 ‘‘(C) TRAINING.—The Secretary shall pro- 13 vide, not later than October 1, 2021, for the com- 14 prehensive training of State and Federal sur- 15 veyors, and any surveyor employed by a na- 16 tional accreditation body described in paragraph 17 (2)(A)(i), in the conduct of surveys under this 18 subsection, including training with respect to the 19 review of written plans for providing hospice 20 care (as described in section 1814(a)(7)(B)). No 21 individual shall serve as a member of a survey 22 team with respect to a survey conducted on or 23 after such date unless the individual has success- 24 fully completed a training and testing program 25 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 5821 RH in survey and certification techniques that has 1 been approved by the Secretary. 2 ‘‘(5) FUNDING.—The Secretary shall provide for 3 the transfer, from the Federal Hospital Insurance 4 Trust Fund under section 1817 to the Centers for 5 Medicare & Medicaid Program Management Account, 6 of $10,000,000 for each fiscal year (beginning with 7 fiscal year 2022) for purposes of carrying out surveys 8 under this subsection. Sums so transferred shall re- 9 main available until expended. Any transfer pursu- 10 ant to this paragraph shall be in addition to any 11 transfer pursuant to section 3(a)(2) of the Improving 12 Medicare Post-Acute Care Transformation Act of 13 2014. 14 ‘‘(b) SPECIAL FOCUS PROGRAM.— 15 ‘‘(1) IN GENERAL.—The Secretary shall conduct 16 a special focus program for enforcement of require- 17 ments for hospice programs that the Secretary has 18 identified as having substantially failed to meet ap- 19 plicable requirements of this Act. 20 ‘‘(2) PERIODIC SURVEYS.—Under such special 21 focus program, the Secretary shall conduct surveys of 22 each hospice program in the special focus program 23 not less than once every 6 months. 24 ‘‘(c) ENFORCEMENT.— 25 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 5821 RH ‘‘(1) SITUATIONS INVOLVING IMMEDIATE JEOP- 1 ARDY.—If the Secretary determines on the basis of a 2 standard survey or otherwise that a hospice program 3 that is certified for participation under this title is 4 no longer in compliance with the requirements speci- 5 fied in section 1861(dd) and determines that the defi- 6 ciencies involved immediately jeopardize the health 7 and safety of the individuals to whom the program 8 furnishes items and services, the Secretary shall take 9 immediate action to remove the jeopardy and correct 10 the deficiencies through the remedy described in para- 11 graph (5)(B)(iii) or terminate the certification of the 12 program, and may provide, in addition, for 1 or 13 more of the other remedies described in paragraph 14 (5)(B). 15 ‘‘(2) SITUATIONS NOT INVOLVING IMMEDIATE 16 JEOPARDY.—If the Secretary determines on the basis 17 of a standard survey or otherwise that a hospice pro- 18 gram that is certified for participation under this 19 title is no longer in compliance with the requirements 20 specified in section 1861(dd) and determines that the 21 deficiencies involved do not immediately jeopardize 22 the health and safety of the individuals to whom the 23 program furnishes items and services, the Secretary 24 may (for a period not to exceed 6 months) impose 25 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 5821 RH remedies developed pursuant to paragraph (5)(A), in 1 lieu of terminating the certification of the program. 2 If, after such a period of remedies, the program is 3 still no longer in compliance with such requirements, 4 the Secretary shall terminate the certification of the 5 program. 6 ‘‘(3) PENALTY FOR PREVIOUS NONCOMPLI- 7 ANCE.—If the Secretary determines that a hospice 8 program that is certified for participation under this 9 title is in compliance with the requirements specified 10 in section 1861(dd) but, as of a previous period, did 11 not meet such requirements, the Secretary may pro- 12 vide for a civil monetary penalty under paragraph 13 (5)(B)(i) for the days in which the Secretary finds 14 that the program was not in compliance with such re- 15 quirements. 16 ‘‘(4) OPTION TO CONTINUE PAYMENTS FOR NON- 17 COMPLIANT HOSPICE PROGRAMS.—The Secretary may 18 continue payments under this title with respect to a 19 hospice program not in compliance with the require- 20 ments specified in section 1861(dd) over a period of 21 not longer than 6 months, if— 22 ‘‘(A) the State or local survey agency finds 23 that it is more appropriate to take alternative 24 action to assure compliance of the program with 25 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 5821 RH such requirements than to terminate the certifi- 1 cation of the program; 2 ‘‘(B) the program has submitted a plan and 3 timetable for corrective action to the Secretary 4 for approval and the Secretary approves the 5 plan of corrective action; and 6 ‘‘(C) the program agrees to repay to the 7 Federal Government payments received under 8 this title during such period if the corrective ac- 9 tion is not taken in accordance with the ap- 10 proved plan and timetable. 11 The Secretary shall establish guidelines for approval 12 of corrective actions requested by hospice programs 13 under this paragraph. 14 ‘‘(5) REMEDIES.— 15 ‘‘(A) DEVELOPMENT.— 16 ‘‘(i) IN GENERAL.—Not later than Oc- 17 tober 1, 2021, the Secretary shall develop 18 and implement— 19 ‘‘(I) a range of remedies to apply 20 to hospice programs under the condi- 21 tions described in paragraphs (1) 22 through (4); and 23 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 5821 RH ‘‘(II) appropriate procedures for 1 appealing determinations relating to 2 the imposition of such remedies. 3 Remedies developed pursuant to the pre- 4 ceding sentence shall include the remedies 5 specified in subparagraph (B). 6 ‘‘(ii) CONDITIONS OF IMPOSITION OF 7 REMEDIES.—Not later than October 1, 8 2021, the Secretary shall develop and imple- 9 ment specific procedures with respect to the 10 conditions under which each of the remedies 11 developed under clause (i) is to be applied, 12 including the amount of any fines and the 13 severity of each of these remedies. Such pro- 14 cedures shall be designed so as to minimize 15 the time between identification of defi- 16 ciencies and imposition of these remedies 17 and shall provide for the imposition of in- 18 crementally more severe fines for repeated 19 or uncorrected deficiencies. 20 ‘‘(B) SPECIFIED REMEDIES.—The remedies 21 specified in this subparagraph are the following: 22 ‘‘(i) Civil monetary penalties in an 23 amount not to exceed $10,000 for each day 24 of noncompliance by a hospice program 25 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 5821 RH with the requirements specified in section 1 1861(dd). 2 ‘‘(ii) Suspension of all or part of the 3 payments to which a hospice program 4 would otherwise be entitled under this title 5 with respect to items and services furnished 6 by a hospice program on or after the date 7 on which the Secretary determines that 8 remedies should be imposed pursuant to 9 paragraph (2). 10 ‘‘(iii) The appointment of temporary 11 management to oversee the operation of the 12 hospice program and to protect and assure 13 the health and safety of the individuals 14 under the care of the program while im- 15 provements are made in order to bring the 16 program into compliance with all such re- 17 quirements. 18 ‘‘(C) PROCEDURES.— 19 ‘‘(i) CIVIL MONETARY PENALTIES.— 20 ‘‘(I) IN GENERAL.—Subject to 21 subclause (II), the provisions of section 22 1128A (other than subsections (a) and 23 (b)) shall apply to a civil monetary 24 penalty under this subsection in the 25 VerDate Sep 11 2014 21:06 Dec 18, 2020 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6203 E:\BILLS\H5821.RH H5821 pamtmann on DSKBC07HB2PROD with BILLS 13 •HR 5821 RH same manner as such provisions apply 1 to a penalty or proceeding under sec- 2 tion 1128A(a). 3 ‘‘(II) RETENTION OF AMOUNTS 4 FOR HOSPICE PROGRAM IMPROVE- 5 MENTS.—The Secretary may provide 6 that any portion of civil monetary 7 penalties collected under this subsection 8 may be used to support activities that 9 benefit individuals receiving hospice 10 care, including education and training 11 programs to ensure hospice program 12 c [Text truncated for display. Full text available on Congress.gov.]