,,ib ,union ,calendar ,no4 #edd #aafth ,,congress #b;d ,session ,h4 ,r4 #ehba ,report ,no4 #aaf-ffj1 ,part ,i ,,in ,,the ,,house ,,of ,,representatives ,february #aj1 #bjbj,mr4 ,panetta 7for himself1 ,mr4 ,reed1 and ,mr4 ,higgins of ,new ,york7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,december #ag1 #bjbj;,additional sponsors3 ,mr4 ,kildee and ,mr4 ,rice of ,south ,carolina ,december #ag1 #bjbj,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 #ag1 #bjbj;,committee on ,energy and ,commerce discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed,for text of introduced bill1 see copy of bill as introduced on ,february #aj1 #bjbj ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish hospice program survey and enforcement procedures under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,helping ,our ,senior ,population in ,comfort ,environments ,act or the ,,hospice ,act4 #b4 ,establishing hospice program survey and enforcement procedures under the ,medicare program 7a7 ,survey and enforcement procedures 7#a7 ,in general ,part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 is amended by adding at the end the following new section3 #ahbb4 ,hospice program survey and enforcement procedures 7a7 ,surveys 7#a7 ,frequency ,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 7and not less frequently than once every #bd months beginning ,october #a1 #bjba74 7#b7 ,public transparency of survey and certification information 7,a7 ,submission of information to the ,secretary 7i7 ,in general ,each ,state1 and each national accreditation body with respect to which the ,secretary has made a finding under section #ahfe7;a7 respecting the accreditation of a hospice program by such body1 shall submit1 in a form and manner1 and at a time1 specified by the ,secretary for purposes of this subparagraph1 information respecting any survey or certification made with respect to a hospice program by such ,state or body1 as applicable4 ,such information shall include any inspection report made by such ,state or body with respect to such survey or certification1 any enforcement actions taken as a result of such survey or certification1 and any other information determined appropriate by the ,secretary4 7ii7 ,required inclusion of specified form ,with respect to a survey under this subsection carried out by a national accreditation body described in clause 7i7 on or after ,october #a1 #bjba1 information described in such clause shall include ,form #befg 7or a successor form71 along with such additional information determined appropriate by such body4 7,b7 ,public disclosure of information ,beginning not later than ,october #a1 #bjbb1 the ,secretary shall publish the information submitted under subparagraph 7,a7 on the public website of the ,centers for ,medicare ,medicaid ,services in a manner that is prominent1 easily accessible1 readily understandable1 and searchable4 ,the ,secretary shall provide for the timely update of such information so published4 7#c7 ,consistency of surveys ,each ,state and the ,secretary shall implement programs to measure and reduce inconsistency in the application of survey results among surveyors4 7#d7 ,survey teams 7,a7 ,in general ,in the case of a survey conducted under this subsection on or after ,october #a1 #bjba1 by more than #a individual1 such survey shall be conducted by a multidisciplinary team of professionals 7including a registered professional nurse74 7,b7 ,prohibition of conflicts of interest ,beginning ,october #a1 #bjba1 a ,state may not use as a member of a survey team under this subsection an individual who is serving 7or has served within the previous #b years7 as a member of the staff of1 or as a consultant to1 the program surveyed respecting compliance with the requirements of section #ahfa7;dd7 or who has a personal or familial financial interest in the program being surveyed4 7,c7 ,training ,the ,secretary shall provide1 not later than ,october #a1 #bjba1 for the comprehensive training of ,state and ,federal surveyors1 and any surveyor employed by a national accreditation body described in paragraph 7#b77;,a77i71 in the conduct of surveys under this subsection1 including training with respect to the review of written plans for providing hospice care 7as described in section #ahad7;a77#g77;,b774 ,no individual shall serve as a member of a survey team with respect to a survey conducted on or after such date unless the individual has successfully completed a training and testing program in survey and certification techniques that has been approved by the ,secretary4 7#e7 ,funding ,the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag to the ,centers for ,medicare ,medicaid ,program ,management ,account1 of #aj1jjj1jjj for each fiscal year 7beginning with fiscal year #bjbb7 for purposes of carrying out surveys under this subsection4 ,sums so transferred shall remain available until expended4 ,any transfer pursuant to this paragraph shall be in addition to any transfer pursuant to section #c7;a77#b7 of the ,improving ,medicare ,post-,acute ,care ,transformation ,act of #bjad4 7b7 ,special focus program 7#a7 ,in general ,the ,secretary shall conduct a special focus program for enforcement of requirements for hospice programs that the ,secretary has identified as having substantially failed to meet applicable requirements of this ,act4 7#b7 ,periodic surveys ,under such special focus program1 the ,secretary shall conduct surveys of each hospice program in the special focus program not less than once every #f months4 7c7 ,enforcement 7#a7 ,situations involving immediate jeopardy ,if the ,secretary determines on the basis of a standard survey or otherwise that a hospice program that is certified for participation under this title is no longer in compliance with the requirements specified in section #ahfa7;dd7 and determines that the deficiencies involved immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services1 the ,secretary shall take immediate action to remove the jeopardy and correct the deficiencies through the remedy described in paragraph 7#e77;,b77iii7 or terminate the certification of the program1 and may provide1 in addition1 for #a or more of the other remedies described in paragraph 7#e77;,b74 7#b7 ,situations not involving immediate jeopardy ,if the ,secretary determines on the basis of a standard survey or otherwise that a hospice program that is certified for participation under this title is no longer in compliance with the requirements specified in section #ahfa7;dd7 and determines that the deficiencies involved do not immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services1 the ,secretary may 7for a period not to exceed #f months7 impose remedies developed pursuant to paragraph 7#e77;,a71 in lieu of terminating the certification of the program4 ,if1 after such a period of remedies1 the program is still no longer in compliance with such requirements1 the ,secretary shall terminate the certification of the program4 7#c7 ,penalty for previous noncompliance ,if the ,secretary determines that a hospice program that is certified for participation under this title is in compliance with the requirements specified in section #ahfa7;dd7 but1 as of a previous period1 did not meet such requirements1 the ,secretary may provide for a civil monetary penalty under paragraph 7#e77;,b77i7 for the days in which the ,secretary finds that the program was not in compliance with such requirements4 7#d7 ,option to continue payments for noncompliant hospice programs ,the ,secretary may continue payments under this title with respect to a hospice program not in compliance with the requirements specified in section #ahfa7;dd7 over a period of not longer than #f months1 if-- 7,a7 the ,state or local survey agency finds that it is more appropriate to take alternative action to assure compliance of the program with such requirements than to terminate the certification of the program2 7,b7 the program has submitted a plan and timetable for corrective action to the ,secretary for approval and the ,secretary approves the plan of corrective action2 and 7,c7 the program agrees to repay to the ,federal ,government payments received under this title during such period if the corrective action is not taken in accordance with the approved plan and timetable4 ,the ,secretary shall establish guidelines for approval of corrective actions requested by hospice programs under this paragraph4 7#e7 ,remedies 7,a7 ,development 7i7 ,in general ,not later than ,october #a1 #bjba1 the ,secretary shall develop and implement-- 7,i7 a range of remedies to apply to hospice programs under the conditions described in paragraphs 7#a7 through 7#d72 and 7,,ii7 appropriate procedures for appealing determinations relating to the imposition of such remedies4 ,remedies developed pursuant to the preceding sentence shall include the remedies specified in subparagraph 7,b74 7ii7 ,conditions of imposition of remedies ,not later than ,october #a1 #bjba1 the ,secretary shall develop and implement specific procedures with respect to the conditions under which each of the remedies developed under clause 7i7 is to be applied1 including the amount of any fines and the severity of each of these remedies4 ,such procedures shall be designed so as to minimize the time between identification of deficiencies and imposition of these remedies and shall provide for the imposition of incrementally more severe fines for repeated or uncorrected deficiencies4 7,b7 ,specified remedies ,the remedies specified in this subparagraph are the following3 7i7 ,civil monetary penalties in an amount not to exceed #aj1jjj for each day of noncompliance by a hospice program with the requirements specified in section #ahfa7;dd74 7ii7 ,suspension of all or part of the payments to which a hospice program would otherwise be entitled under this title with respect to items and services furnished by a hospice program on or after the date on which the ,secretary determines that remedies should be imposed pursuant to paragraph 7#b74 7iii7 ,the appointment of temporary management to oversee the operation of the hospice program and to protect and assure the health and safety of the individuals under the care of the program while improvements are made in order to bring the program into compliance with all such requirements4 7,c7 ,procedures 7i7 ,civil monetary penalties 7,i7 ,in general ,subject to subclause 7,,ii71 the provisions of section #aabh;,a 7other than subsections 7a7 and 7b77 shall apply to a civil monetary penalty under this subsection in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a7a74 7,,ii7 ,retention of amounts for hospice program improvements ,the ,secretary may provide that any portion of civil monetary penalties collected under this subsection may be used to support activities that benefit individuals receiving hospice care1 including education and training programs to ensure hospice program compliance with the requirements of section #ahfa7;dd74 7ii7 ,suspension of payment ,a finding to suspend payment under subparagraph 7,b77ii7 shall terminate when the ,secretary finds that the program is in substantial compliance with all such requirements4 7iii7 ,temporary management ,the temporary management under subparagraph 7,b77iii7 shall not be terminated until the ,secretary has determined that the program has the management capability to ensure continued compliance with all the requirements referred to in such subparagraph4 7,d7 ,relationship to other remedies ,the remedies developed under subparagraph 7,a7 are in addition to sanctions otherwise available under ,state or ,federal law and shall not be construed as limiting other remedies1 including any remedy available to an individual at common law4 4 7#b7 ,availability of hospice accreditation surveys ,section #ahfe7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;bb7b77 is amended by inserting or1 beginning on the date of the enactment of the ,,hospice ,act1 a hospice program after home health agency4 7#c7 ,state provision of hospice program information 7,a7 ,in general ,section #ahfd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aa7a77 is amended in the sixth sentence-- 7i7 by inserting and hospice programs after information on home health agencies2 7ii7 by inserting or the hospice program after the home health agency2 7iii7 by inserting or the hospice program after with respect to the agency2 and 7iv7 by inserting and hospice programs after with respect to home health agencies4 7,b7 ,effective date ,the amendments made by subparagraph 7,a7 shall apply with respect to agreements entered into on or after1 or in effect as of1 the date that is #a year after the date of the enactment of this ,act4 7#d7 ,conforming amendments 7,a7 ,definition of a hospice program ,section #ahfa7;dd77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77#d77 is amended by striking subparagraph 7,c74 7,b7 ,continuation of funding ,section #c7;a77#b7 of the ,improving ,medicare ,post-,acute ,care ,transformation ,act of #bjad is amended by inserting and section #ahbb7;a77#a7 of such ,act1 after as added by paragraph 7#a714 7b7 ,increasing payment reductions for failure to meet quality data reporting requirements ,section #ahad7;i77#e77;,a77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7i77#e77;,a77i77 is amended by inserting 7or1 for fiscal year #bjbc and each subsequent fiscal year1 #d percentage points7 before the period4 7c7 ,report ,not later than #cf months after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report containing an analysis of the effects of the amendments made by subsection 7a71 including the frequency of application of remedies specified in section #ahbb7;c77#e77;,b7 of the ,social ,security ,act 7as added by such subsection71 on access to1 and quality of1 care furnished by hospice programs under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq474 ,december #ag1 #bjbj,reported from the ,committee on ,ways and ,means with an amendment,december #ag1 #bjbj;,committee on ,energy and ,commerce discharged2 committed to the ,committee of the ,whole ,house on the ,state of the ,union and ordered to be printed