,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #bhjg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,novemb] #g1 #bjai,mr4 
,portman 7= himself & ,mr4 ,c>d97       
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve ! quality ( c>e furni%$ by      
hospice programs "u ! ,m$ic>e program4  
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,hospice ,c>e ,improvem5t ,act (      
#bjai4  #b4 ,improv+ quality report+ &  
transp>5cy = hospice c>e  7a7 ,increas+ 
report$ hospice data  7#a7 ,availability
 ( hospice accr$itation surveys  7,a7 ,9
 g5]al ,section #ahfe7;b7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acie;bb7b77 is am5d$ by ins]t+ or a    
hospice program aft] home heal? ag5cy4  
7,b7 ,effective date ,! am5dm5t made by 
subp>agraph 7,a7 %all apply to surveys  
conduct$ on or aft] ! date ( ! enactm5t 
( ?is ,act4  7#b7 ,inclusion ( reports  
by ,/ate & local survey ag5cies &       

approv$ accr$itation ag5cies on ,hospice
 comp>e ,section #ahfa7;dd77#d7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7dd77#d77 is am5d$ by add+ at !   
end ! foll[+ new subp>agraph3  7,d7 7i7 
,n lat] ?an #f mon?s aft] ! date ( !    
enactm5t ( ?is subp>agraph1 ! ,secret>y1
 subject to clauses 7ii7 & 7iii71 %all  
include on :at is commonly ref]r$ to z !
 ,hospice ,comp>e int]net website 7or   
any successor website7 in=mation f      
reports by ,/ate & local survey ag5cies 
& approv$ accr$itation ag5cies describ$ 
9 subp>agraph 7,c77i74  7ii7 ,!         
in=mation requir$ to be includ$ "u      
clause 7i7 %all be pres5t$ 9 a mann] t  
is prom95t1 updat$ & remov$ on a timely 
basis1 t>get$ to defici5cies relat$ to  
quality ( c>e1 easily accessible1       
readily und]/&able to consum]s ( hospice
 s]vices1 & se>*able4 ,su* in=mation    
%all also include a l9k to ! reports4   
7iii7 ,9 det]m9+ ! in=mation requir$ to 
be includ$ "u clause 7i7 & ! =mat ( su* 
in=mation "u 7ii71 ! ,secret>y %all     

consult )--  7,i7 employees ( hospice   
programs & _! repres5tatives2  7,,ii7   
provid] /akehold] gr\ps2  7,,iii7       
accr$itation organizations2  7,,iv7     
,/ate & local survey ag5cies2  7,v7     
c>egiv]s ( curr5t or =m] hospice        
pati5ts2 &  7,,vi7 any o!r              
repres5tatives ( programs or gr\ps !    
,secret>y det]m9es appropriate4  4  7#c7
 ,increas$ defici5cy data report+ by    
approv$ hospice accr$itation ag5cies ,n 
lat] ?an #f mon?s aft] ! date ( !       
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all exp& !    
in=mation t approv$ accr$itation ag5cies
 7z describ$ 9 section                  
#ahfa7;dd77#d77;,c77i7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciex7dd77#d77;,c77i7771 z am5d$ by    
subsection 7b71 are requir$ to report ) 
respect to defici5cies by a hospice     
program to be comp>able to ! in=mation t
 ,/ate & local survey ag5cies 7z        
describ$ 9 su* section7 report ) respect
 to su* defici5cies4  7b7 ,improv+ !    

hospice survey process ,section         
#ahfa7;dd77#d77;,c7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#aciex7dd77#d77;,c77 is am5d$ to read z 
foll[s3  7,c7 7i7 ,subject to ! succe$+ 
provisions ( ?is subp>agraph1 beg9n+ #f 
mon?s aft] ! date ( enactm5t ( !        
,improv+ ,m$ic>e ,po/-,acute ,c>e       
,trans=mation ,act ( #bjad1 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?s4  7ii7 ,any entity
 t is fir/ c]tifi$ z a hospice program  
aft] ! date ( enactm5t ( ! ,hospice ,c>e
 ,improvem5t ,act ( #bjai %all be       
subject to a /&>d survey describ$ 9     
clause 7i7 )9 #ab mon?s ( su*           
c]tification4 ,aft] su* /&>d survey1 su*
 entity %all be subject to /&>d surveys 
9 accordance ) clause 7i74  7iii7 ,any  
entity t is subject to an int]m$iate    
sanction "u p>agraph 7#f7 %all be       

subject to a /&>d survey describ$ 9     
clause 7i7 n less ?an once e #ab mon?s  
until su* "t t ! entity is f\nd by !    
,/ate or local survey ag5cy or approv$  
accr$itation ag5cy to be 9 compliance ) 
! requirem5ts "u ?is title = a p]iod (  
#bd mon?s4  7iv7 ,if a ,/ate & local    
survey ag5cy or an approv$ accr$itation 
ag5cy id5tifies a defici5cy ( an entity 
z "p ( a /&>d survey conduct$ pursuant  
to ?is subp>agraph1 ! ag5cy %all notify 
! entity ( ! f9d+ & provide ! entity )  
7or provide access to7 educational      
in=mation on h[ to address ! defici5cy &
 prev5t future defici5cies4 ,su*        
educational in=mation 7or access to su* 
in=mation7 %all be provid$ to ! entity  
^u ! completion ( ! site visit p]=m$ z  
"p ( ! survey4 ,su* educational         
in=mation %all be /&>diz$ = purposes (  
bo? educat+ hospice programs & surveyors
 f local survey ag5cies & approv$       
accr$itation ag5cies4  7v7 ,! ,secret>y 
%all e/abli% a process = jo9t tra9+ &   
education ( ,/ate & local survey        

ag5cies1 approv$ accr$itation ag5cies1 &
 hospice programs on a regul> basis z   
*anges to regulations1 guidel9es1 &     
policies gov]n+ hospice program         
op]ations are implem5t$ & us$ 9 /&>d    
surveys ( p>ticipat+ hospice programs4  
4  7c7 ,annual report ( defici5cies     
7#a7 ,/udy ,! ,secret>y ( ,heal? &      
,human ,s]vices 79 ?is section ref]r$ to
 z ! ,secret>y7 %all conduct an annual  
/udy on defici5cies by a hospice        
programs "u ! ,m$ic>e program4 ,su* /udy
 %all include an analysis ( ways to     
address su* defici5cies4  7#b7 ,report  
,n lat] ?an ,janu>y #a1 #bjba1 !        
,secret>y %all submit to ,congress a    
report on ! /udy conduct$ "u p>agraph   
7#a71 toge!r ) recomm5dations = su*     
legislation & adm9i/rative action z !   
,secret>y det]m9es appropriate4  #c4    
,increas+ compliance ( quality /&>ds =  
hospice c>e  7a7 ,increas+ paym5t       
r$uctions = fail+ ,to report quality    
measures ,section #ahad7;i77#e77;,a77i7 
( ! ,social ,security ,act 7#db         

,u4,s4,c4 #acie;f7i77#e77;,a77i77 is    
am5d$ by ins]t+ or1 = fiscal ye> #bjba &
 subsequ5t fiscal ye>s1 #d p]c5tage     
po9ts be=e ! p]iod at ! end4  7b7       
,au?ority ,to impose int]m$iate         
sanctions ,section #ahfa7;dd7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7dd77 is am5d$ by add+ at ! end ! 
foll[+ p>agraph3  7#f7 ,beg9n+ #a ye>   
aft] ! date ( enactm5t ( ! ,hospice ,c>e
 ,improvem5t ,act ( #bjai1 if !         
,secret>y det]m9es bas$ on ! results ( a
 survey t a hospice program no long]    
meets ! applicable requirem5ts ( ?is    
,act1 ! ,secret>y--  7,a7 %all issue    
guidance on ways to det]m9e ! me*anisms 
= impos+ a range ( int]m$iate sanctions 
on hospice programs2 &  7,b7 may impose 
an int]m$iate sanction on ! hospice     
program1 includ+ b n limit$ to1 !       
foll[+3  7i7 ,susp5sion ( all or "p ( ! 
paym5ts to :i* a hospice program w\ld   
o!rwise be entitl$ "u ?is title = all   
new admissions on or aft] ! date on :i* 
! ,secret>y det]m9es t int]m$iate       

sanctions %\ld be impos$4  7ii7 ,!      
appo9tm5t ( tempor>y managem5t to ov]see
 ! op]ation ( ! hospice program & to    
protect & assure ! heal? & safety (     
individuals "u ! c>e ( ! hospice program
 :ile improvem5ts are made 9 ord] to br+
 ! hospice program into compliance ) all
 ! requirem5ts specifi$ 9 ?is section4  
7iii7 ,implem5tation ( a direct$ plan ( 
correction "u :i* ! ,secret>y or !      
tempor>y manag] may direct ! hospice    
program to take specific corrective     
action to a*ieve specific outcomes )9   
specific timeframes4  7iv7 ,if !        
,secret>y det]m9es t education is likely
 to correct ! defici5cies1 imposition ( 
a requirem5t t all hospice program /aff 
att5d 9-s]vice tra9+ programs deem$     
acceptable by ! ,secret>y4  4