,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #hhhc  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #ai1 #bjbf ,ms4  
,van ,duyne 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$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
provide = additional ov]sight ( hospice 
programs & home heal? ag5cies "u !      
,m$ic>e program1 & = o!r purposes4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,protect+ ,s5iors & ,/opp+ ,fraud/]s    
,act4  #b4 ,revalidat+ enrollm5t (      
hospice programs 9 c]ta9 ,/ates  7a7 ,9 
g5]al ,section #ahff7;j7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#acie;cc7j77 is am5d$ by add+ at ! end !
 foll[+ new p>agraph3  7#aj7            
,revalidation ( hospice programs 9 c]ta9
 ,/ates  7,a7 ,9 g5]al ,9 ! case t !    

,secret>y provides1 pursuant to p>agraph
 7#c77;,a71 t new hospice programs      
locat$ 9 a ,/ate are subject to !       
enhanc$ ov]sight describ$ 9 su* p>agraph
 "u ! program "u ?is title1 ! ,secret>y 
%all1 n lat] ?an #a ye> aft] ! date     
specifi$ 9 subp>agraph 7,b7 ) respect to
 su* enhanc$ ov]sight requirem5t1       
revalidate ! enrollm5t 9 ! program "u   
?is title ( ea* hospice program locat$ 9
 su* ,/ate t-- 7i7 is n a new hospice   
program2 &  7ii7 0 n subject to su*     
revalidation dur+ ! #ah-mon? p]iod      
prec$+ su* date4  7,b7 ,date specifi$ ,=
 purposes ( subp>agraph 7,a71 ! date    
specifi$ 9 ?is subp>agraph is1 ) respect
 to an enhanc$ ov]sight requirem5t      
describ$ 9 subp>agraph 7,a7--  7i7 9 !  
case t su* requirem5t took effect be=e !
 date ( enactm5t ( ?is p>agraph & is 9  
effect on su* date ( enactm5t1 su* date 
( enactm5t2 &  7ii7 9 ! case t su*      
requirem5t takes effect on or aft] !    
date ( enactm5t ( ?is p>agraph1 su*     
effective date4  4  7b7 ,te*nical       

correction ,section #ahff7;j77#c77;,a7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acie;cc7j77#c77;,a77 is am5d$ by /rik+
 title ,,xix4 & & ins]t+ title ,,xix1 &4
  #c4 ,additional ov]sight provisions = 
hospice programs  7a7 ,increas$ survey  
frequ5cy = c]ta9 hospice programs       
,section #ahbb7;a77#a7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;i-#f7;a77#a77 is am5d$--  7#a7 by 
/rik+ ,any entity & ins]t+3  7,a7 ,9    
g5]al ,subject to subp>agraph 7,b71 any 
entity  2 &  7#b7 by add+ at ! end !    
foll[+ new subp>agraph3  7,b7 ,increas$ 
frequ5cy = c]ta9 hospice programs  7i7  
,newly enroll$2 *ange ( own]%ip2        
reactivat$ bill+ privileges ,beg9n+ #a  
ye> aft] ! date ( enactm5t ( ?is clause1
 a hospice program t is newly enroll$ "u
 ?is title1 has und]gone a *ange (      
own]%ip 7z def9$ by ! ,secret>y71 or has
 reactivat$ bill+ privileges "u ?is     
title 9 accordance ) section            
#dbd4edj7;b7 ( title #db1 ,code ( ,f$]al
 ,regulations 7or a successor           

regulation71 %all be subject to su* a   
survey n less frequ5tly ?an once e #ab  
mon?s dur+ ! #cf-mon? p]iod imm$iately  
foll[+ su* enrollm5t1 *ange1 or         
reactivation4  7ii7 ,additional hospice 
programs  7,i7 ,9 g5]al ,subject to     
subclause 7,,ii71 beg9n+ #a ye> aft] !  
date ( enactm5t ( ?is clause-- 7aa7 a   
hospice program t did n submit quality  
data to ! ,secret>y 9 accordance )      
section #ahad7;i77#e77;,c7 = ! mo/ rec5t
 fiscal ye> = :i* data is available 7z  
det]m9$ by ! ,secret>y7 %all be subject 
to su* a survey n lat] ?an #ah mon?s    
aft] ! mo/ rec5t su* survey conduct$ )  
respect to su* hospice program2 &  7bb7 
a hospice program t has a live dis*>ge  
rate t is ab]rant comp>$ to pe]s 7z     
det]m9$ by ! ,secret>y7 or o!rwise      
displays *>act]i/ics or engages 9       
practices t may indicate fraudul5t or   
ab]rant behavior 7z specifi$ by !       
,secret>y aft] consultation )           
/akehold]s1 su* z b5efici>y advocates & 
repres5tatives ( ! hospice indu/ry1 & ! 

,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?
 & ,human ,s]vices1 & updat$ z necess>y 
aft] additional consultation ) su*      
/akehold]s n less (t5 ?an once e #c     
ye>s7 %all be subject to su* a survey n 
lat] ?an #ah mon?s aft] ! mo/ rec5t su* 
survey conduct$ ) respect to su* hospice
 program4  7,,ii7 ,limit+ duplicative   
surveys ,a hospice program %all n be    
subject to m ?an #a survey "u ?is clause
 )9 any #ah-mon? p]iod4  4  7b7 ,paym5t 
adju/m5t if quality data n submitt$     
,section #ahad7;i77#e7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;f7i77#e77 is am5d$-- 7#a7 9       
subp>agraph 7,a77i7--  7,a7 by /rik+ =  
fiscal ye> #bjbd & ea* subsequ5t fiscal 
ye> & ins]t+ = fiscal ye>s #bjbd ?r\gh  
#bjbh2 &  7,b7 by ins]t+ 1 or1 = fiscal 
ye> #bjbi & ea* subsequ5t fiscal ye>1   
#ae p]c5tage po9ts aft] #d p]c5tage     
po9ts2 &  7#b7 9 subp>agraph 7,c71 by   
add+ at ! end ! foll[+ new s5t5ce3 ,=   
fiscal ye> #bjbi & ea* subsequ5t fiscal 
ye>1 9 specify+ a "t = ! submission (   

su* data pursuant to ! previ\s s5t5ce1 !
 ,secret>y %all e/abli% a process "u :i*
 any hospice program t has demon/rat$ a 
good fai? ef=t to submit su* data by su*
 "t may be grant$ additional "t 7n to   
exce$ #cj days7 to complete su*         
submission44  #d4 ,additional ov]sight  
provisions = home heal? ag5cies  7a7    
,increas$ survey frequ5cy = c]ta9 home  
heal? ag5cies ,section                  
#ahia7;c77#b77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;bbb7c77#b77;,b77 is am5d$--  7#a7 
9 clause 7ii71 by /rik+ ! p]iod at ! end
 & ins]t+ a semicolon2  7#b7 by         
r$esignat+ clauses 7i7 & 7ii7 z         
subclauses 7,i7 & 7,,ii71 respectively1 
& adju/+ ! m>g9s accord+ly2  7#c7 by    
/rik+ 1 a /&>d survey & ins]t+ ! foll[+3
 --  7i7 a /&>d survey  2 &  7#d7 by    
add+ at ! end ! foll[+ new clauses3     
7ii7 beg9n+ #a ye> aft] ! date (        
enactm5t ( ?is clause1 9 ! case t !     
ag5cy is newly enroll$ "u ?is title1 has
 und]gone a *ange ( own]%ip 7z def9$ by 

! ,secret>y71 or has reactivat$ bill+   
privileges "u ?is title 9 accordance )  
section #dbd4edj7;b7 ( title #db1 ,code 
( ,f$]al ,regulations 7or a successor   
regulation71 a /&>d survey ( an ag5cy   
%all be conduct$ n less frequ5tly ?an   
once e #ab mon?s dur+ ! #cf-mon? p]iod  
imm$iately foll[+ su* enrollm5t1 *ange1 
or reactivation2 &  7iii7 beg9n+ #a ye> 
aft] ! date ( enactm5t ( ?is clause1 a  
/&>d survey ( an ag5cy %all be          
conduct$--  7,i7 9 ! case t ! ag5cy did 
n submit quality data to ! ,secret>y 9  
accordance ) subclauses 7,,ii7 & 7,,iv7 
( section #ahie7;b77#c77;,b77v7 = ! mo/ 
rec5t ye> = :i* data is available 7z    
det]m9$ by ! ,secret>y71 n lat] ?an #ah 
mon?s aft] ! mo/ rec5t su* survey       
conduct$ ) respect to su* ag5cy2 &      
7,,ii7 9 ! case t ! ag5cy has a         
b5efici>y admission rate t is ab]rant   
comp>$ to pe]s 7z det]m9$ by !          
,secret>y7 or o!rwise displays          
*>act]i/ics or engages 9 practices t may
 indicate fraudul5t or ab]rant behavior 

7z specifi$ by ! ,secret>y aft]         
consultation ) /akehold]s1 su* z        
b5efici>y advocates & repres5tatives ( !
 home heal? indu/ry1 & ! ,inspector     
,g5]al ( ! ,dep>tm5t ( ,heal? & ,human  
,s]vices1 & updat$ z necess>y aft]      
additional consultation ) su* /akehold]s
 n less (t5 ?an once e #c ye>s71 n lat] 
?an #ah mon?s aft] ! mo/ rec5t su*      
survey conduct$ ) respect to su* ag5cy1 
except t an ag5cy %all n be subject to m
 ?an #a survey "u ?is clause )9 any     
#ah-mon? p]iod4  4  7b7 ,paym5t adju/m5t
 if quality data n submitt$ ,section    
#ahie7;b77#c77;,b77v7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;fff7b77#c77;,b77v77 is am5d$--    
7#a7 9 subclause 7,i7--  7,a7 by /rik+  
applicable "u su* clause = su* ye> &    
ins]t+ applicable "u su* clause = #bjjg 
& ea* subsequ5t ye> ?r\gh #bjbh2 &  7,b7
 by ins]t+ 1 &1 = #bjbi & ea* subsequ5t 
ye>1 %all be r$uc$ by #ae p]c5tage po9ts
 aft] #b p]c5tage po9ts2  7#b7 9        
subclause 7,,ii71 by add+ at ! end !    

foll[+ new s5t5ce3 ,= #bjbi & ea*       
subsequ5t ye>1 9 specify+ a "t = !      
submission ( su* data pursuant to !     
previ\s s5t5ce1 ! ,secret>y %all e/abli%
 a process "u :i* any home heal? ag5cy t
 has demon/rat$ a good fai? ef=t to     
submit su* data by su* "t may be grant$ 
additional "t 7n to exce$ #cj days7 to  
complete su* submission42 &  7#c7 9     
subclause 7,,iv77cc71 by add+ at ! end !
 foll[+ new s5t5ce3 ,= #bjbi & ea*      
subsequ5t ye>1 9 specify+ a "t = !      
submission ( su* data pursuant to !     
previ\s s5t5ce1 ! ,secret>y %all e/abli%
 a process "u :i* any home heal? ag5cy t
 has demon/rat$ a good fai? ef=t to     
submit su* data by su* "t may be grant$ 
additional "t 7n to exce$ #cj days7 to  
complete su* submission44  #e4 ,enhanc+ 
enrollm5t scre5+ = hospice programs &   
home heal? ag5cies ,section             
#ahff7;j77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;cc7j77#b77 is     
am5d$-- 7#a7 9 subp>agraph 7,b7--  7,a7 
9 clause 7i71 by /rik+ & at ! end2  7,b7

 9 clause 7ii77,v71 by /rik+ ! p]iod at 
! end & ins]t+ 2 &2 &  7,c7 by add+ at !
 end ! foll[+ new clause3  7iii7 beg9n+ 
#a ye> aft] ! date ( enactm5t ( ?is     
clause1 9 ! case ( a hospice program or 
home heal? ag5cy apply+ = enrollm5t "u  
?is title t is at an extreme risk (     
fraud 7z det]m9$ "u subp>agraph 7,g771  
%all1 9 addition to any o!r scre5+      
requir$ "u ?is subp>agraph--  7,i7 9 !  
case t f+]pr9t+ is includ$ 9 su* scre5+ 
) respect to hospice programs or home   
heal? ag5cies 7z applicable7 pursuant to
 clause 7ii77,,ii71 require f+]pr9t+ ( !
 adm9i/rator & ! m$ical director ( su*  
hospice program or home heal? ag5cy2 &  
7,,ii7 require obta9+ evid5ce t su*     
hospice program or home heal? ag5cy has 
a compreh5sive liability insurance      
policy1 z det]m9$ by ! ,secret>y4  2 &  
7#b7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,g7 ,hospice programs &  
home heal? ag5cies at extreme risk (    
fraud  7i7 ,9 g5]al ,beg9n+ #a ye> aft] 
! date ( enactm5t ( ?is subp>agraph1 =  

purposes ( subp>agraph 7,b77iii71 !     
,secret>y %all det]m9e :e!r a hospice   
program or home heal? ag5cy is at an    
extreme risk ( fraud bas$ on--  7,i7 !  
det]m9ation made "u clause 7ii72 &      
7,,ii7 su* o!r factors z ! ,secret>y may
 specify4  7ii7 ,det]m9ation ( high-risk
 areas ,= purposes ( clause 7i71 !      
,secret>y %all det]m9e :e!r a hospice   
program or home heal? ag5cy is locat$ 9 
a ,/ate or c\nty ) respect to :i*1 dur+ 
! mo/ rec5t ye> = :i* data is available1
 ! total numb] ( hospice programs or    
home heal? ag5cies 7z applicable7 locat$
 9 su* ,/ate or c\nty significantly     
exce$$ ! total numb] ( su* programs or  
ag5cies locat$ 9 su* ,/ate or c\nty dur+
 ! prec$+ ye>4  4  #f4 ,additional      
survey & tra9+ requirem5ts =            
accr$itation organizations ,section     
#ahfe ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acie;bb7 is am5d$--  7#a7 9  
subsection 7a77#b7-- 7,a7 by /rik+ ,9   
mak+ & ins]t+ ! foll[+3  7,a7 ,9 mak+  2
 &  7,b7 by add+ at ! end ! foll[+ new  

subp>agraph3  7,b77i7 ,beg9n+ #a ye>    
aft] ! date ( enactm5t ( ?is            
subp>agraph1 ! ,secret>y may n approve a
 reque/ = a f9d+ "u p>agraph 7#a7 )     
respect to a national accr$itation body 
unless ! survey proc$ures ( su*         
accr$itation body--  7,i7 met or exce$$ 
! /&>ds applicable to ! survey proc$ures
 t ,/ate & local ag5cies t h ent]$ into 
an agreem5t ) ! ,secret>y "u section    
#ahfd7;a7 are requir$ to use2 &  7,,ii7 
require surveyors to complete ! relevant
 basic surveyor tra9+ c\rses (f]$ by !  
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices be=e
 s]v+ z a memb] ( a survey team4  7ii7  
,! ,secret>y may only cont9ue to give   
effect to any su* f9d+ made prior to !  
date t is #a ye> aft] ! date ( enactm5t 
( ?is subp>agraph ) respect to a        
national accr$itation body if !         
,secret>y det]m9es be=e su* date t !    
survey proc$ures ( su* accr$itation body
 meet ! conditions describ$ 9 clause 7i7
 4  2 &  7#b7 by add+ at ! end ! foll[+ 
new subsection3  7f77#a7 ,n lat] ?an #a 

ye> aft] ! date ( enactm5t ( ?is        
subsection1 ! ,secret>y %all e/abli% &  
implem5t a me*anism = p]iodically       
assess+ ! p]=mance ( an accr$itation    
body t has receiv$ approval f !         
,secret>y "u subsection 7a77#c77;,a7 =  
accr$itation ( provid] entities4  7#b7  
,9 ! case t ! ,secret>y f9ds1 pursuant  
to ! me*anism e/abli%$ "u p>agraph 7#a71
 t ! p]=mance ( su* accr$itation body is
 defici5t1 ! ,secret>y %all provide = an
 appropriate rem$y1 :i* may include !   
imposition ( a corrective action plan1  
ongo+ monitor+ ( ! accr$itation body1 & 
! t]m9ation ( su* approval ) respect to 
! accr$itation body = accr$itation ( su*
 provid] entities4  4  #g4 ,ext5d+      
adju/m5t to calculation ( hospice cap   
am\nt "u ,m$ic>e ,section               
#ahad7;i77#b77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;f7i77#b77;,b7
 is am5d$--  7#a7 9 clause 7ii71 by     
/rik+ #bjce & ins]t+ #bjcf2 &  7#b7 9   
clause 7iii71 by /rik+ #bjce & ins]t+   
#bjcf4  #h4 ,requir+ notice reg>d+      

revocation ( hospice program election "u
 ,m$ic>e  7a7 ,9 g5]al ,section         
#ahab7;d77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;d7d77#b77 is am5d$
 by add+ at ! end ! foll[+ new          
subp>agraph3  7,e7 ,) respect to        
elections "u ?is p>agraph made on or    
aft] ! date t is #a ye> aft] ! date (   
enactm5t ( ?is subp>agraph1 ! ,secret>y 
%all1 n lat] ?an #ae cal5d> days aft] ! 
effective date ( su* election1 provide  
to su* individual writt5 notice ( su*   
election4 ,su* notice %all display !    
toll-free telephone numb]               
#a-hjj-,,m$ic>e1 & %all include--  7i7 !
 "n1 address1 & telephone numb] ( !     
hospice program ) respect to :i* su*    
election is made2  7ii7 a description1 9
 pla9 language1 ( ! waiv] ( rights      
applicable "u subp>agraph 7,a72 &  7iii7
 an explanation ( h[ su* individual may 
revoke su* election "u subp>agraph 7,b7 
or *ange ! hospice program ) respect to 
:i* su* election is made "u subp>agraph 
7,c74  4  7b7 ,fund+ ,section #ahab ( ! 

,social ,security ,act 7#db ,u4,s4,c4   
#acie;d7 is am5d$ by add+ at ! end !    
foll[+ new subsection3  7h7 ,fund+ =    
election notices ,! ,secret>y %all      
provide = ! transf]1 f ! ,f$]al         
,hospital ,insurance ,tru/ ,fund "u     
section #ahag to ! ,c5t]s = ,m$ic>e     
,m$icaid ,s]vices ,program ,managem5t   
,acc\nt1 ( #f1jjj1jjj = ea* fiscal ye>  
7beg9n+ ) fiscal ye> #bjbf7 = purposes (
 c>ry+ out subsection 7d77#b77;,e74     
,sums s transf]r$ %all rema9 available  
until exp5d$4  4  #i4 ,report on program
 integrity activities  7a7 ,9 g5]al ,n  
lat] ?an ! date t is #a ye> aft] ! date 
( ! enactm5t ( ?is section1 & annually  
!reaft] = a p]iod ( #e ye>s1 ! ,secret>y
 ( ,heal? & ,human ,s]vices %all report 
to ! appropriate committees ( ,congress 
on ! outcome ( program integrity        
activities conduct$ ) respect to hospice
 programs or home heal? ag5cies enroll$ 
"u title ,,xviii ( ! ,social ,security  
,act 7#db ,u4,s4,c4 #acie et seq471 :i* 
%all include ! foll[+ in=mation )       

respect to ! prec$+ ye>3  7#a7 ,a       
description ( ea* type ( entity ( !     
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices t   
conduct$ reviews1 audits1 or any o!r    
program integrity activities ) respect  
to hospice programs or home heal?       
ag5cies enroll$ "u title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq474  7#b7 ,! numb] (        
reviews1 audits1 or o!r program         
integrity activities p]=m$ by ea* su*   
type ( entity ) respect to hospice      
programs or home heal? ag5cies4  7#c7 ,a
 description ( any tr5ds1 includ+       
in/ances ( individual physicians ) high 
rates ( ineligible c]tifications1       
id5tifi$ by su* entities ) respect to   
improp] paym5ts made to hospice programs
 or home heal? ag5cies4  7#d7 ,any f9d+s
 made by su* entities ) respect to      
reviews1 audits1 or o!r program         
integrity activities conduct$ ) respect 
to hospice programs & home heal?        
ag5cies4  7#e7 ,! numb] & nature (      
en=cem5t actions tak5 by ! ,c5t]s =     

,m$ic>e  ,m$icaid ,s]vices ) respect to 
hospice programs & home heal? ag5cies z 
a result ( ! f9d+s describ$ 9 p>agraph  
7#d71 includ+ ! numb] ( revocations (   
enrollm5t 9 ! ,m$ic>e program "u title  
,,xviii ( ! ,social ,security ,act 7#db 
,u4,s4,c4 #acie et seq47 ( hospice      
programs & home heal? ag5cies4  7#f7 ,a 
description ( any actions tak5 by !     
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices to  
r$uce duplication ( ef=ts among su*     
entities1 includ+ any actions tak5 to   
prev5t or mitigate ! adm9i/rative burd5 
on hospice programs & home heal? ag5cies
 associat$ ) program integrity          
activities4  7b7 ,def9itions ,9 ?is     
section3 7#a7 ,appropriate committees ( 
,congress ,! t]m appropriate committees 
( ,congress means--  7,a7 ! ,committee  
on ,ways & ,means & ! ,committee on     
,en]gy & ,comm]ce ( ! ,h\se (           
,repres5tatives2 &  7,b7 ! ,committee on
 ,f9ance ( ! ,s5ate4  7#b7 ,home heal?  
ag5cy ,! t]m home heal? ag5cy has !     
mean+ giv5 su* t]m 9 section #ahfa7o7 ( 

! ,social ,security ,act 7#db ,u4,s4,c4 
#aciex7o774  7#c7 ,hospice program ,!   
t]m hospice program has ! mean+ giv5 su*
 t]m 9 section #ahfa7;dd77#b7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7dd77#b774  #aj4 ,fund+ ,!        
,secret>y ( ,heal? & ,human ,s]vices    
%all provide = ! transf] f ! ,f$]al     
,hospital ,insurance ,tru/ ,fund        
e/abli%$ "u section #ahag ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acie;i7  
to ! ,c5t]s = ,m$ic>e  ,m$icaid         
,s]vices' ,program ,managem5t ,acc\nt ( 
#ajj1jjj1jjj = fiscal ye> #bjbf =       
purposes ( c>ry+ out section            
#ahbb7;a77#a7 ( su* ,act1 z am5d$ by    
section section #c7;a71 & section       
#ahia7;c77#b7 ( su* ,act1 z am5d$ by    
section section #d7;a74 ,sums s         
transf]r$ %all rema9 available until    
exp5d$4 ,any transf] pursuant to ?is    
subsection %all be 9 addition to any    
transf] pursuant to section #c7;a77#b7 (
 ! ,improv+ ,m$ic>e ,po/-,acute ,c>e    
,trans=mation ,act ( #bjad4