,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #cjcg  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #ac1 #bjae ,mr4 
,re$ 7= himself & ,mr4 ,?ompson (       
,cali=nia7 introduc$ ! foll[+ bill2 :i* 
0 ref]r$ to ! ,committee on ,ways &     
,means  ,a ,,bill  ,to am5d title       
,,xviii ( ! ,social ,security ,act to   
improve access to hospice c>e "u !      
,m$ic>e program1 & = o!r purposes4  #a4 
,%ort title ,?is ,act may cit$ z !      
,hospice ,c>e ,access ,improvem5t ,act (
 #bjae4  #b4 ,hospice paym5t re=m       
demon/ration program  7a7 ,9 g5]al ,!   
,secret>y ( ,heal? & ,human ,s]vices 79 
?is ,act ref]r$ to z ! ,secret>y7 %all  
conduct a demon/ration program = a      
#a-ye> p]iod dur+ fiscal ye> #bjaf to   
te/ ! propos$ hospice paym5t me?odology 
revisions4  7b7 ,propos$ ,hospice       
,paym5t ,me?odology ,revisions def9$ ,9 
?is section1 ! t]m propos$ hospice      
paym5t me?odology revisions means       
revisions to ! me?odology = det]m9+     
hospice paym5t rates "u section         

#ahad7;i77#f77;,d7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;f7i77#f77;,d77 conta9$ 9 ! ,fiscal
 ,ye> #bjaf ,hospice ,wage ,index &     
,paym5t ,rate ,update & ,hospice        
,quality ,report+ ,requirem5ts z publi%$
 by ! ,c5t]s = ,m$ic>e  ,m$icaid        
,s]vices on ,may #e1 #bjae 7#hj ,f$4    
,reg4 #behca et seq474  7c7 ,scope ,!   
,secret>y %all select "o ,m$ic>e        
adm9i/rative contractor to conduct !    
demon/ration program4 ,su* contractor   
%all conduct ! demon/ration program )   
respect to all hospice programs "u t    
contractor's jurisdiction4  7d7         
,evaluation ,! ,secret>y %all conduct an
 evaluation ( ! demon/ration program1   
:i* %all include an analysis ( ! impact 
( ! propos$ hospice paym5t me?odology   
revisions--  7#a7 on ! quality ( pati5t 
c>e & ! ability ( hospice programs to   
provide su* c>e2 &  7#b7 on access to   
hospice c>e = b5efici>ies4  7e7 ,report 
,n lat] ?an ,m>* #ca1 #bjag1 ! ,secret>y
 %all submit to ,congress a report on ! 

demon/ration program4 ,! report %all    
include--  7#a7 ! results ( ! evaluation
 "u subsection 7d72 &  7#b7             
recomm5dations = su* legislation &      
adm9i/rative action z ! ,secret>y       
det]m9es appropriate4  7f7              
,implem5tation ( hospice paym5t         
me?odology revisions  7#a7 ,prohibition 
on implem5tation ( revisions = fiscal   
ye>s #bjaf & #bjag ,no revisions to !   
hospice paym5t me?odology %all be made  
"u section #ahad7;i77#f77;,d7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#acie;f7i77#f77;,d77 = fiscal ye>s #bjaf
 & #bjag1 except = purposes ( !         
demon/ration program requir$ to be      
conduct$ "u subsection 7a74  7#b7       
,implem5tation ( revisions = fiscal ye> 
#bjah ,aft] tak+ into acc\nt ! results (
 ! evaluation ( ! demon/ration program &
 aft] mak+ any necess>y revisions1 !    
,secret>y %all implem5t ! propos$       
hospice paym5t me?odology revisions     
beg9n+ ) fiscal ye> #bjah4  #c4 ,hospice
 program integrity  7a7 ,m$ical review =

 c]ta9 hospice programs ,section        
#ahad7;i7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;f7i77 is am5d$ by  
add+ at ! end ! foll[+ new p>agraph3    
7#h7 ,m$ical review = c]ta9 hospice     
programs  7,a7 ,9 g5]al ,! ,secret>y    
%all implem5t a process = ! m$ical      
review ( hospice c>e furni%$ by a       
hospice program id5tifi$ "u subp>agraph 
7,b74  7,b7 ,id5tification ( hospice    
programs = m$ical review ,! ,secret>y   
%all id5tify hospice programs ! pati5ts 
( :i* w be subject to m$ical review "u  
subp>agraph 7,a74 ,9 id5tify+ su*       
programs1 ! ,secret>y %all consid]      
multiple factors 9 comp>ison ) o!r      
simil>ly situat$ hospice programs1 su*  
z--  7i7 ! p]c5tage ( pati5ts :o 7      
dis*>g$ aft] receiv+ hospice c>e = a    
p]iod ( #abj to #ahj days & :o 7 alive  
^u su* dis*>ge2  7ii7 ! p]c5tage (      
pati5ts :o are receiv+ hospice c>e f !  
program at ! end ( life :o receive no   
skill$ hospice c>e visits 9 ! la/ week (
 life2 &  7iii7 ! level ( p]-pati5t     

exp5ditures "u ?is title = pati5ts ( !  
hospice program exclud+ exp5ditures =   
hospice c>e4  7,c7 ,limitation on       
liability ( b5efici>y :]e m$ic>e claims 
are disall[$ ,! provisions ( ?is title  
relat+ to ! limitation on liability ( a 
b5efici>y :]e ,m$ic>e claims are        
disall[$ %all apply ) respect to ?is    
p>agraph 9 ! same mann] z !y apply to   
subsection 7a77#g77;,e74  4  7b7        
,develop+ int]v5tions ,to r$uce hospital
 admissions ,! ,secret>y %all develop & 
publi% guidance1 :]e appropriate & 9    
consultation ) int]e/$ p>ties1 = hospice
 programs to develop int]v5tions to     
r$uce hospital admissions & visits to   
hospital em]g5cy dep>tm5ts by pati5ts ( 
su* hospice programs4  7c7 ,exp&+ :o may
 p]=m pre-,hospice evaluation & c\nsel+ 
s]vices  7#a7 ,9 g5]al ,section         
#ahab7;a77#e7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;d7a77#e77 is am5d$
 by ins]t+ aft] hospice program !       
foll[+3 1 or s]vices t are furni%$ by a 
regi/]$ nurse :o is an employee ( a     

hospice program 9 consultation1 if      
necess>y1 ) o!r memb]s ( !              
int]discipl9>y gr\p describ$ 9 section  
#ahfa7;dd77#b77;,b714  7#b7 ,evaluation 
& report  7,a7 ,evaluation ,! ,secret>y 
%all evaluate ! impact ( ! am5dm5t made 
by p>agraph 7#a74 ,su* evaluation %all  
include an evaluation ( ! impact ( su*  
am5dm5t on hospital admission rates1    
hospice c>e utilization1 & l5g? ( /ay 9 
hospice programs = pati5ts receiv+      
s]vices "u section #ahab7;a77#e7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;d7a77#e774  7,b7 ,report ,!       
,secret>y %all submit a report to       
,congress conta9+ ! results ( !         
evaluation "u subp>agraph 7,a74  7d7    
,exp&+ hospice c>e access = resid5ts us+
 skill$ nurs+ facilities  7#a7 ,m$ic>e &
 skill$ nurs+ facilities ,section #ahai 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i-#c7 is am5d$-- 7,a7 9 
subsection 7b77#d71 by add+ at ! end !  
foll[+ new subp>agraph3  7,d7 ,hospice  
program contract+ ,9 ! case ( a facility

 t contracts ) a hospice program =      
hospice c>e = its resid5ts1 su* facility
 %all make a good fai? ef=t to ent] into
 a contract ) m ?an "o hospice program  
p>ticipat+ "u ?is title t provides      
s]vices 9 ! area s]v$ by ! facility1 if 
m ?an "o hospice program is available to
 s]ve su* resid5ts4  2 &  7,b7 9        
subsection 7c77#a77;,a77i71 by ins]t+   
aft] well-be+1 ! foll[+3 to be fully    
in=m$1 9 a =m & mann] specifi$ by !     
,secret>y1 ( any f9ancial int]e/1 z     
specifi$ by ! ,secret>y1 ! skill$ nurs+ 
facility has 9 any hospice program to   
:i* a resid5t is ref]r$14  7#b7         
,effective date ,! am5dm5ts made by ?is 
subsection %all apply to skill$ nurs+   
facilities 9 op]ation #a ye> aft] ! date
 ( ! enactm5t ( ?is ,act4  7e7 ,hospital
 dis*>ge plann+ provisions relat+ to    
hospice c>e  7#a7 ,9 g5]al ,section     
#ahfa7;ee77#b7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciex7ee77#b77 is  
am5d$-- 7,a7 9 subp>agraph 7,d71 by     
/rik+ ! p]iod at ! end & ins]t+ &1 9 !  

case ( individuals likely to ne$ hospice
 c>e1 ! availability ( su* c>e ?r\gh    
hospice programs t p>ticipate 9 !       
program "u ?is title & t s]ve ! area 9  
:i* ! pati5t resides & t reque/ to be   
li/$ by ! hospital z available42 &  7,b7
 9 subp>agraph 7,h77i71 by ins]t+ or    
hospice c>e aft] home heal? s]vices4    
7#b7 ,effective date ,! am5dm5ts made by
 ?is subsection %all apply to dis*>ges  
occurr+ on or aft] #ij days aft] ! date 
( ! enactm5t ( ?is ,act4