,,ii #aacth ,,congress #ast ,session ,s4 #ajec ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #bc1 #bjac ,mr4 ,wyden 7for himself and ,mr4 ,roberts7 introduced the following bill2 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 programs4 #a4 ,short title ,this ,act may be cited as the ,hospice ,evaluation and ,legitimate ,payment ,act of #bjac4 #b4 ,ensuring timely access to hospice care 7a7 ,in general ,section #ahad7;a77#g77;,d77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7a77#g77;,d77i77 is amended to read as follows3 7i7 a hospice physician1 nurse practitioner1 clinical nurse specialist1 or physician assistant 7as those terms are defined in section #ahfa7;aa77#e771 or other health professional 7as designated by the ,secretary71 has a face-to-face encounter with the individual to determine continued eligibility of the individual for hospice care prior to the first #fj-;day period and each subsequent recertification under subparagraph 7,a77ii7 7or1 in the case where a hospice program newly admits an individual who would be entering their first #fj-;day period or a subsequent hospice benefit period or where exceptional circumstances1 as defined by the ,secretary1 may prevent a face-to-face encounter prior to the beginning of the hospice benefit period1 not later than #g calendar days after the individual's election under section #ahab7;d77#a7 with respect to the hospice program7 and attests that such visit took place 7in accordance with procedures established by the ,secretary72 and 4 7b7 ,effective date ,the amendment made by subsection 7a7 takes effect on ,january #a1 #bjad1 and applies to hospice care furnished on or after such date4 #c4 ,restoring and protecting the ,medicare hospice benefit 7a7 ,in general ,section #ahad7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7i77 is amended-- 7#a7 in paragraph 7#f7-- 7,a7 in subparagraph 7,d7-- 7i7 in clause 7i7-- 7,i7 in the first sentence1 by striking not earlier than ,october #a1 #bjac1 the ,secretary shall1 by regulation1 and inserting subject to clause 7iii71 not earlier than the later of #b years after the demonstration program under subparagraph 7,f7 is completed or ,october #a1 #bjag1 the ,secretary shall1 by regulation1 preceded by a notice of the proposed regulation in the ,federal ,register and a period for public comment in accordance with section #ahga7;b77#a712 and 7,,ii7 in the second sentence1 by inserting and shall take into account the results of the evaluation conducted under subparagraph 7,f77ii7 before the period2 and 7ii7 by adding at the end the following new clause3 7iii7 ,the ,secretary shall implement the revisions in payment pursuant to clause 7i7 unless the ,secretary determines that the demonstration program under subparagraph 7,f7 demonstrated that such revisions would adversely affect access to quality hospice care by beneficiaries under this title4 2 and 7,b7 by adding at the end the following new subparagraph3 7,f7 ,hospice payment reform demonstration program 7i7 ,establishment of demonstration program 7,i7 ,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 7,d71 the ,secretary shall establish a ,medicare ,hospice ,payment ,reform demonstration program 7in this subparagraph referred to as the demonstration program7 to test such proposed revisions4 7,,ii7 ,duration ,the demonstration program shall be conducted for a #b-year period beginning on or after ,october #a1 #bjac4 7,,iii7 ,scope ,any certified hospice program may apply to participate in the demonstration program and the ,secretary shall select not more than #ae such hospice programs to participate in the demonstration program4 7,,iv7 ,representative participation ,hospice programs selected under subclause 7,,iii7 to participate in the demonstration program shall include a representative cross-section of hospice programs throughout the ,united ,states1 including programs located in urban and rural areas4 7ii7 ,evaluation and report 7,i7 ,evaluation ,the ,secretary shall conduct an evaluation of the demonstration program4 ,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 providers1 including the impact1 if any1 on the ability of hospice programs to furnish quality care to beneficiaries under this title4 7,,ii7 ,report ,not later than #b years after the completion of the demonstration program1 the ,secretary shall submit to ,congress a report containing the results of the evaluation conducted under subclause 7,i71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 7iii7 ,budget neutrality ,with respect to the #b-year period of the demonstration program1 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 program4 4 #d4 ,hospice survey requirement ,section #ahfa7;dd77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77#d77 is amended by adding at the end the following new subparagraph3 7,c7 ,any entity that is certified as a hospice program shall be subject to a standard survey by an appropriate ,state or local survey agency1 or an approved accreditation agency1 as determined by the ,secretary1 not less frequently than once every #cf months beginning #f months after the date of the enactment of this subparagraph4 4