,,ib ,union ,cal5d> ,no4 #edd #aaf?     
,,congress  #b;d ,session  ,h4 ,r4 #ehba
 ,report ,no4 #aaf-ffj1 ,"p ,i ,,9 ,,!  
,,h\se ,,( ,,repres5tatives  ,febru>y   
#aj1 #bjbj,mr4 ,panetta 7= himself1 ,mr4
 ,re$1 & ,mr4 ,higg9s ( ,new ,york7     
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means1 & 9    
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$    
,decemb] #ag1 #bjbj;,additional         
sponsors3 ,mr4 ,kildee & ,mr4 ,rice (   
,s\? ,c>ol9a  ,decemb] #ag1             
#bjbj,report$ f ! ,committee on ,ways & 
,means ) an amendment,strike out all    
aft] ! enact+ clause & ins]t ! "p pr9t$ 
9 italic  ,decemb] #ag1 #bjbj;,committee
 on ,en]gy & ,comm]ce dis*>g$2 committ$ 
to ! ,committee ( ! ,:ole ,h\se on !    
,/ate ( ! ,union & ord]$ to be          
printed,for text ( introduc$ bill1 see  
copy ( bill z introduc$ on ,febru>y #aj1

 #bjbj  ,a ,,bill  ,to am5d title       
,,xviii ( ! ,social ,security ,act to   
e/abli% hospice program survey &        
en=cem5t proc$ures "u ! ,m$ic>e program1
 & = o!r purposes4  #a4 ,%ort title ,?is
 ,act may be cit$ z ! ,help+ ,our ,s5ior
 ,population 9 ,com=t ,environm5ts ,act 
or ! ,,hospice ,act4  #b4 ,e/abli%+     
hospice program survey & en=cem5t       
proc$ures "u ! ,m$ic>e program  7a7     
,survey & en=cem5t proc$ures  7#a7 ,9   
g5]al ,"p ,a ( title ,,xviii ( ! ,social
 ,security ,act 7#db ,u4,s4,c4 #acie;c  
et seq47 is am5d$ by add+ at ! end !    
foll[+ new section3  #ahbb4 ,hospice    
program survey & en=cem5t proc$ures  7a7
 ,surveys  7#a7 ,frequ5cy ,any entity t 
is c]tifi$ z a hospice program %all be  
subject to a /&>d survey by an          
appropriate ,/ate or local survey ag5cy1
 or an approv$ accr$itation ag5cy1 z    
det]m9$ by ! ,secret>y1 n less frequ5tly
 ?an once e #cf mon?s 7& n less         
frequ5tly ?an once e #bd mon?s beg9n+   
,octob] #a1 #bjba74  7#b7 ,public       

transp>5cy ( survey & c]tification      
in=mation  7,a7 ,submission ( in=mation 
to ! ,secret>y  7i7 ,9 g5]al ,ea* ,/ate1
 & ea* national accr$itation body )     
respect to :i* ! ,secret>y has made a   
f9d+ "u section #ahfe7;a7 respect+ !    
accr$itation ( a hospice program by su* 
body1 %all submit1 9 a =m & mann]1 & at 
a "t1 specifi$ by ! ,secret>y = purposes
 ( ?is subp>agraph1 in=mation respect+  
any survey or c]tification made )       
respect to a hospice program by su*     
,/ate or body1 z applicable4 ,su*       
in=mation %all include any inspection   
report made by su* ,/ate or body )      
respect to su* survey or c]tification1  
any en=cem5t actions tak5 z a result (  
su* survey or c]tification1 & any o!r   
in=mation det]m9$ appropriate by !      
,secret>y4  7ii7 ,requir$ inclusion (   
specifi$ =m ,) respect to a survey "u   
?is subsection c>ri$ out by a national  
accr$itation body describ$ 9 clause 7i7 
on or aft] ,octob] #a1 #bjba1 in=mation 
describ$ 9 su* clause %all include ,=m  

#befg 7or a successor =m71 along ) su*  
additional in=mation det]m9$ appropriate
 by su* body4  7,b7 ,public disclosure (
 in=mation ,beg9n+ n lat] ?an ,octob]   
#a1 #bjbb1 ! ,secret>y %all publi% !    
in=mation submitt$ "u subp>agraph 7,a7  
on ! public website ( ! ,c5t]s = ,m$ic>e
  ,m$icaid ,s]vices 9 a mann] t is      
prom95t1 easily accessible1 readily     
und]/&able1 & se>*able4 ,! ,secret>y    
%all provide = ! timely update ( su*    
in=mation s publi%$4  7#c7 ,consi/5cy ( 
surveys ,ea* ,/ate & ! ,secret>y %all   
implem5t programs to measure & r$uce    
inconsi/5cy 9 ! application ( survey    
results among surveyors4  7#d7 ,survey  
teams  7,a7 ,9 g5]al ,9 ! case ( a      
survey conduct$ "u ?is subsection on or 
aft] ,octob] #a1 #bjba1 by m ?an #a     
individual1 su* survey %all be conduct$ 
by a multidiscipl9>y team ( pr(essionals
 7includ+ a regi/]$ pr(essional nurse74 
7,b7 ,prohibition ( conflicts ( int]e/  
,beg9n+ ,octob] #a1 #bjba1 a ,/ate may n
 use z a memb] ( a survey team "u ?is   

subsection an individual :o is s]v+ 7or 
has s]v$ )9 ! previ\s #b ye>s7 z a memb]
 ( ! /aff (1 or z a consultant to1 !    
program survey$ respect+ compliance ) ! 
requirem5ts ( section #ahfa7;dd7 or :o  
has a p]sonal or familial f9ancial      
int]e/ 9 ! program be+ survey$4  7,c7   
,tra9+ ,! ,secret>y %all provide1 n lat]
 ?an ,octob] #a1 #bjba1 = ! compreh5sive
 tra9+ ( ,/ate & ,f$]al surveyors1 & any
 surveyor employ$ by a national         
accr$itation body describ$ 9 p>agraph   
7#b77;,a77i71 9 ! conduct ( surveys "u  
?is subsection1 includ+ tra9+ ) respect 
to ! review ( writt5 plans = provid+    
hospice c>e 7z describ$ 9 section       
#ahad7;a77#g77;,b774 ,no individual %all
 s]ve z a memb] ( a survey team )       
respect to a survey conduct$ on or aft] 
su* date unless ! individual has        
successfully complet$ a tra9+ & te/+    
program 9 survey & c]tification         
te*niques t has be5 approv$ by !        
,secret>y4  7#e7 ,fund+ ,! ,secret>y    
%all provide = ! transf]1 f ! ,f$]al    

,hospital ,insurance ,tru/ ,fund "u     
section #ahag to ! ,c5t]s = ,m$ic>e     
,m$icaid ,program ,managem5t ,acc\nt1 ( 
#aj1jjj1jjj = ea* fiscal ye> 7beg9n+ )  
fiscal ye> #bjbb7 = purposes ( c>ry+ out
 surveys "u ?is subsection4 ,sums s     
transf]r$ %all rema9 available until    
exp5d$4 ,any transf] pursuant to ?is    
p>agraph %all be 9 addition to any      
transf] pursuant to section #c7;a77#b7 (
 ! ,improv+ ,m$ic>e ,po/-,acute ,c>e    
,trans=mation ,act ( #bjad4  7b7        
,special focus program  7#a7 ,9 g5]al ,!
 ,secret>y %all conduct a special focus 
program = en=cem5t ( requirem5ts =      
hospice programs t ! ,secret>y has      
id5tifi$ z hav+ sub/antially fail$ to   
meet applicable requirem5ts ( ?is ,act4 
7#b7 ,p]iodic surveys ,"u su* special   
focus program1 ! ,secret>y %all conduct 
surveys ( ea* hospice program 9 !       
special focus program n less ?an once e 
#f mon?s4  7c7 ,en=cem5t  7#a7          
,situations involv+ imm$iate jeop>dy ,if
 ! ,secret>y det]m9es on ! basis ( a    

/&>d survey or o!rwise t a hospice      
program t is c]tifi$ = p>ticipation "u  
?is title is no long] 9 compliance ) !  
requirem5ts specifi$ 9 section          
#ahfa7;dd7 & det]m9es t ! defici5cies   
involv$ imm$iately jeop>dize ! heal? &  
safety ( ! individuals to :om ! program 
furni%es items & s]vices1 ! ,secret>y   
%all take imm$iate action to remove !   
jeop>dy & correct ! defici5cies ?r\gh ! 
rem$y describ$ 9 p>agraph 7#e77;,b77iii7
 or t]m9ate ! c]tification ( ! program1 
& may provide1 9 addition1 = #a or m ( !
 o!r rem$ies describ$ 9 p>agraph        
7#e77;,b74  7#b7 ,situations n involv+  
imm$iate jeop>dy ,if ! ,secret>y        
det]m9es on ! basis ( a /&>d survey or  
o!rwise t a hospice program t is c]tifi$
 = p>ticipation "u ?is title is no long]
 9 compliance ) ! requirem5ts specifi$ 9
 section #ahfa7;dd7 & det]m9es t !      
defici5cies involv$ d n imm$iately      
jeop>dize ! heal? & safety ( !          
individuals to :om ! program furni%es   
items & s]vices1 ! ,secret>y may 7= a   

p]iod n to exce$ #f mon?s7 impose       
rem$ies develop$ pursuant to p>agraph   
7#e77;,a71 9 lieu ( t]m9at+ !           
c]tification ( ! program4 ,if1 aft] su* 
a p]iod ( rem$ies1 ! program is /ill no 
long] 9 compliance ) su* requirem5ts1 ! 
,secret>y %all t]m9ate ! c]tification ( 
! program4  7#c7 ,p5alty = previ\s      
noncompliance ,if ! ,secret>y det]m9es t
 a hospice program t is c]tifi$ =       
p>ticipation "u ?is title is 9          
compliance ) ! requirem5ts specifi$ 9   
section #ahfa7;dd7 b1 z ( a previ\s     
p]iod1 did n meet su* requirem5ts1 !    
,secret>y may provide = a civil monet>y 
p5alty "u p>agraph 7#e77;,b77i7 = ! days
 9 :i* ! ,secret>y f9ds t ! program 0 n 
9 compliance ) su* requirem5ts4  7#d7   
,option to cont9ue paym5ts =            
noncompliant hospice programs ,!        
,secret>y may cont9ue paym5ts "u ?is    
title ) respect to a hospice program n 9
 compliance ) ! requirem5ts specifi$ 9  
section #ahfa7;dd7 ov] a p]iod ( n long]
 ?an #f mon?s1 if-- 7,a7 ! ,/ate or     

local survey ag5cy f9ds t x is m        
appropriate to take alt]native action to
 assure compliance ( ! program ) su*    
requirem5ts ?an to t]m9ate !            
c]tification ( ! program2  7,b7 !       
program has submitt$ a plan & timetable 
= corrective action to ! ,secret>y =    
approval & ! ,secret>y approves ! plan (
 corrective action2 &  7,c7 ! program   
agrees to repay to ! ,f$]al ,gov]nm5t   
paym5ts receiv$ "u ?is title dur+ su*   
p]iod if ! corrective action is n tak5 9
 accordance ) ! approv$ plan &          
timetable4  ,! ,secret>y %all e/abli%   
guidel9es = approval ( corrective       
actions reque/$ by hospice programs "u  
?is p>agraph4  7#e7 ,rem$ies  7,a7      
,developm5t  7i7 ,9 g5]al ,n lat] ?an   
,octob] #a1 #bjba1 ! ,secret>y %all     
develop & implem5t-- 7,i7 a range (     
rem$ies to apply to hospice programs "u 
! conditions describ$ 9 p>agraphs 7#a7  
?r\gh 7#d72 &  7,,ii7 appropriate       
proc$ures = appeal+ det]m9ations relat+ 
to ! imposition ( su* rem$ies4  ,rem$ies

 develop$ pursuant to ! prec$+ s5t5ce   
%all include ! rem$ies specifi$ 9       
subp>agraph 7,b74  7ii7 ,conditions (   
imposition ( rem$ies ,n lat] ?an ,octob]
 #a1 #bjba1 ! ,secret>y %all develop &  
implem5t specific proc$ures ) respect to
 ! conditions "u :i* ea* ( ! rem$ies    
develop$ "u clause 7i7 is to be appli$1 
includ+ ! am\nt ( any f9es & ! sev]ity (
 ea* ( ^! rem$ies4 ,su* proc$ures %all  
be design$ s z to m9imize ! "t betwe5   
id5tification ( defici5cies & imposition
 ( ^! rem$ies & %all provide = !        
imposition ( increm5tally m sev]e f9es =
 repeat$ or uncorrect$ defici5cies4     
7,b7 ,specifi$ rem$ies ,! rem$ies       
specifi$ 9 ?is subp>agraph are ! foll[+3
 7i7 ,civil monet>y p5alties 9 an am\nt 
n to exce$ #aj1jjj = ea* day (          
noncompliance by a hospice program ) !  
requirem5ts specifi$ 9 section          
#ahfa7;dd74  7ii7 ,susp5sion ( all or "p
 ( ! paym5ts to :i* a hospice program   
w\ld o!rwise be entitl$ "u ?is title )  
respect to items & s]vices furni%$ by a 

hospice program on or aft] ! date on :i*
 ! ,secret>y det]m9es t rem$ies %\ld be 
impos$ pursuant to p>agraph 7#b74  7iii7
 ,! appo9tm5t ( tempor>y managem5t to   
ov]see ! op]ation ( ! hospice program & 
to protect & assure ! heal? & safety ( !
 individuals "u ! c>e ( ! program :ile  
improvem5ts are made 9 ord] to br+ !    
program into compliance ) all su*       
requirem5ts4  7,c7 ,proc$ures  7i7      
,civil monet>y p5alties  7,i7 ,9 g5]al  
,subject to subclause 7,,ii71 !         
provisions ( section #aabh;,a 7o!r ?an  
subsections 7a7 & 7b77 %all apply to a  
civil monet>y p5alty "u ?is subsection 9
 ! same mann] z su* provisions apply to 
a p5alty or proce$+ "u section          
#aabh;,a7a74  7,,ii7 ,ret5tion ( am\nts 
= hospice program improvem5ts ,!        
,secret>y may provide t any portion (   
civil monet>y p5alties collect$ "u ?is  
subsection may be us$ to support        
activities t b5efit individuals receiv+ 
hospice c>e1 includ+ education & tra9+  
programs to ensure hospice program      

compliance ) ! requirem5ts ( section    
#ahfa7;dd74  7ii7 ,susp5sion ( paym5t ,a
 f9d+ to susp5d paym5t "u subp>agraph   
7,b77ii7 %all t]m9ate :5 ! ,secret>y    
f9ds t ! program is 9 sub/antial        
compliance ) all su* requirem5ts4  7iii7
 ,tempor>y managem5t ,! tempor>y        
managem5t "u subp>agraph 7,b77iii7 %all 
n be t]m9at$ until ! ,secret>y has      
det]m9$ t ! program has ! managem5t     
capability to ensure cont9u$ compliance 
) all ! requirem5ts ref]r$ to 9 su*     
subp>agraph4  7,d7 ,relation%ip to o!r  
rem$ies ,! rem$ies develop$ "u          
subp>agraph 7,a7 are 9 addition to      
sanctions o!rwise available "u ,/ate or 
,f$]al law & %all n be con/ru$ z limit+ 
o!r rem$ies1 includ+ any rem$y available
 to an individual at common law4  4     
7#b7 ,availability ( hospice            
accr$itation surveys ,section #ahfe7;b7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie;bb7b77 is am5d$ by      
ins]t+ or1 beg9n+ on ! date ( ! enactm5t
 ( ! ,,hospice ,act1 a hospice program  

aft] home heal? ag5cy4  7#c7 ,/ate      
provision ( hospice program in=mation   
7,a7 ,9 g5]al ,section #ahfd7;a7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;aa7a77 is am5d$ 9 ! six? s5t5ce-- 
7i7 by ins]t+ & hospice programs aft]   
in=mation on home heal? ag5cies2  7ii7  
by ins]t+ or ! hospice program aft] !   
home heal? ag5cy2  7iii7 by ins]t+ or ! 
hospice program aft] ) respect to !     
ag5cy2 &  7iv7 by ins]t+ & hospice      
programs aft] ) respect to home heal?   
ag5cies4  7,b7 ,effective date ,!       
am5dm5ts made by subp>agraph 7,a7 %all  
apply ) respect to agreem5ts ent]$ into 
on or aft]1 or 9 effect z (1 ! date t is
 #a ye> aft] ! date ( ! enactm5t ( ?is  
,act4  7#d7 ,con=m+ am5dm5ts  7,a7      
,def9ition ( a hospice program ,section 
#ahfa7;dd77#d7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciex7dd77#d77 is  
am5d$ by /rik+ subp>agraph 7,c74  7,b7  
,cont9uation ( fund+ ,section #c7;a77#b7
 ( ! ,improv+ ,m$ic>e ,po/-,acute ,c>e  
,trans=mation ,act ( #bjad is am5d$ by  

ins]t+ & section #ahbb7;a77#a7 ( su*    
,act1 aft] z add$ by p>agraph 7#a714    
7b7 ,increas+ paym5t r$uctions = failure
 to meet quality data report+           
requirem5ts ,section                    
#ahad7;i77#e77;,a77i7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;f7i77#e77;,a77i77 is am5d$ by     
ins]t+ 7or1 = fiscal ye> #bjbc & ea*    
subsequ5t fiscal ye>1 #d p]c5tage po9ts7
 be=e ! p]iod4  7c7 ,report ,n lat] ?an 
#cf mon?s aft] ! date ( ! enactm5t ( ?is
 ,act1 ! ,comptroll] ,g5]al ( ! ,unit$  
,/ates %all submit to ! ,committee on   
,ways & ,means ( ! ,h\se (              
,repres5tatives & ! ,committee on       
,f9ance ( ! ,s5ate a report conta9+ an  
analysis ( ! effects ( ! am5dm5ts made  
by subsection 7a71 includ+ ! frequ5cy ( 
application ( rem$ies specifi$ 9 section
 #ahbb7;c77#e77;,b7 ( ! ,social         
,security ,act 7z add$ by su*           
subsection71 on access to1 & quality (1 
c>e furni%$ by hospice programs "u "p ,a
 ( title ,,xviii ( ! ,social ,security  

,act 7#db ,u4,s4,c4 #acie;c et seq474   
,decemb] #ag1 #bjbj,report$ f !         
,committee on ,ways & ,means ) an       
amendment,december #ag1 #bjbj;,committee
 on ,en]gy & ,comm]ce dis*>g$2 committ$ 
to ! ,committee ( ! ,:ole ,h\se on !    
,/ate ( ! ,union & ord]$ to be pr9t$