[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9803 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 9803
To amend title XVIII of the Social Security Act to ensure the integrity
of hospice care furnished under the Medicare program, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 25, 2024
Mr. Blumenauer introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to ensure the integrity
of hospice care furnished under the Medicare program, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Hospice Care Accountability, Reform,
and Enforcement Act of 2024'' or the ``Hospice CARE Act of 2024''.
SEC. 2. ENSURING THE INTEGRITY OF HOSPICE CARE FURNISHED UNDER THE
MEDICARE PROGRAM.
(a) Mandatory Temporary Moratorium on Enrollment.--
(1) In general.--Section 1866(j) of the Social Security Act
(42 U.S.C. 1395cc(j)) is amended by adding at the end the
following new paragraph:
``(10) Mandatory temporary moratorium on enrollment of
hospice programs.--
``(A) In general.--Except as provided in
subparagraphs (B) and (C), the Secretary shall impose a
nationwide temporary moratorium on the enrollment of
new hospice programs under this title for the 5-year
period beginning on the date of the enactment of this
paragraph.
``(B) Exemption for certain hospices.--
``(i) In general.--The Secretary may exempt
a hospice program seeking to enroll under this
title from the moratorium described in
subparagraph (A) if the Secretary determines
that such program will furnish hospice care to
individuals entitled to benefits under part A
in an area with insufficient access to such
care (as specified by the Secretary, taking
into account the considerations described in
clause (ii)).
``(ii) Considerations described.--For
purposes of clause (i), the considerations
described in this clause are, with respect to a
hospice program seeking to enroll under this
title, the following:
``(I) The specific geographic area
that such program intends to serve.
``(II) The current availability of
hospice care in such area.
``(III) Any evidence of unmet need
for hospice care in such area (such as
wait times for such care, the extent to
which such area (or a population in
such area) is considered underserved,
and evidence that existing hospice
programs are provided a substandard
quality of care in such area).
``(IV) The program's plan to
address any identified gaps in the
provision of hospice care in such area.
``(C) Authority to lift moratorium.--The Secretary
may lift the moratorium imposed under subparagraph (A)
within a State (or geographic region of a State)
specified by the Secretary in the same manner as the
Secretary may lift a temporary moratorium (as described
in paragraph (7)) under section 424.570(d) of title 42,
Code of Federal Regulations (or a successor
regulation).
``(D) Application of prepayment medical review
during the temporary moratorium in certain
circumstances.--
``(i) In general.--Subject to clause (ii),
the Secretary shall apply prepayment medical
review to hospice care consisting of routine
home care furnished during the 5-year period
beginning on the date of the enactment of this
paragraph by an applicable hospice program to a
covered individual.
``(ii) Termination of application of
prepayment medical review.--
``(I) In general.--The Secretary
shall terminate the application of
prepayment medical review under clause
(i) with respect to hospice care
furnished by an applicable hospice
program to a covered individual if the
Secretary determines that, during the
period in which such care so furnished
by such program was subject to such
review, such care was subject to a low
rate of denial (as specified by the
Secretary) under such review.
``(II) Revocation of termination.--
The Secretary may revoke any
termination of prepayment medical
review under subclause (I) if
determined appropriate by the
Secretary.
``(iii) Definitions.--For purposes of this
subparagraph:
``(I) Applicable hospice program.--
The term `applicable hospice program'
means a hospice program with a history
of claim submissions with respect to
hospice care furnished under this title
that is aberrant (such as by
demonstrating that such program is an
outlier with respect to live
discharges) compared to such history of
claim submissions of similarly situated
hospice programs, as determined by the
Secretary.
``(II) Covered individual.--The
term `covered individual' means an
individual receiving hospice care under
this title during the second 90-day
period described in section 1812(d)(1)
(or during any subsequent period)
applicable to such individual.
``(E) Revalidation of enrollment information.--
``(i) In general.--During the 6-month
period beginning on the date of the enactment
of this paragraph and notwithstanding any
applicable revalidation cycle under section
424.515 of title 42, Code of Federal
Regulations (or a successor regulation), the
Secretary shall revalidate the enrollment
information of each hospice program enrolled
under this title in accordance with the
requirements applicable to revalidations of
such information under such section.
``(ii) Publication of ownership
information.--Not later than 1 year after the
date of the enactment of this paragraph, the
Secretary shall publish on a public website of
the Centers for Medicare & Medicaid Services
ownership interest and managing control
information collected pursuant to revalidations
described in clause (i) for each hospice
program enrolled under this title.
``(iii) Report.--Not later than January 1,
2027, the Secretary, acting through the
Assistant Secretary for Planning and
Evaluation, shall submit to Congress a report
on hospice ownership and control trends and the
role of private equity in ownership and control
of hospice programs. Such report shall
include--
``(I) validation, to the extent
feasible, of the ownership and control
information reported on form CMS-855A
(or any successor form);
``(II) an analysis of hospice cost
report data by ownership type;
``(III) recommendations on ways to
improve the integrity of the ownership
and control information reported by
hospices during the enrollment process
under this title; and
``(IV) to the extent practicable,
recommendations on policies to promote
health care competition.
``(F) Implementation.--The Secretary shall
implement this paragraph through program instruction or
other forms of subregulatory guidance.''.
(2) Authority to provide exemptions to temporary
moratoria.--Section 1866(j)(7) of the Social Security Act (42
U.S.C. 1395cc(j)(7)) is amended--
(A) in subparagraph (A), by adding at the end the
following new sentence: ``The Secretary may exempt a
provider of services or supplier that would otherwise
be subject to a moratorium imposed under the preceding
sentence from such moratorium if determined appropriate
by the Secretary.''; and
(B) in subparagraph (C)(iii)--
(i) in subclause (I), by striking ``and''
at the end;
(ii) in subclause (II), by striking the
period and inserting ``; and''; and
(iii) by adding at the end the following
new subclause:
``(III) is not subject to an
exemption described in such
subparagraph.''.
(b) Extension of Oversight of Newly-Enrolled Hospice Programs.--
(1) In general.--Section 1866(j)(3)(A) of the Social
Security Act (42 U.S.C. 1395cc(j)(3)(A)) is amended by
inserting ``(or, in the case of a hospice program, not more
than 2 years)'' after ``1 year''.
(2) Mandatory application of enhanced oversight for certain
hospice programs.--Section 1866(j)(3) of the Social Security
Act (42 U.S.C. 1395cc(j)(3)) is amended--
(A) by redesignating subparagraph (B) as
subparagraph (C); and
(B) by inserting after subparagraph (A) the
following new subparagraph:
``(B) Mandatory application to certain hospice
programs.--The procedures established by the Secretary
under subparagraph (A) shall provide that any hospice
program enrolling under this title that would, but for
application of subparagraph (B) or (C) of paragraph
(10), have been prohibited from so enrolling be subject
to the enhanced oversight described in such
subparagraph for a period of not less than 30 days.''.
(c) Increase in Survey Frequency for Certain Hospice Programs.--
Section 1822(a) of the Social Security Act (42 U.S.C. 1395i-6(a)) is
amended--
(1) in paragraph (1)--
(A) by inserting ``, with respect to such a survey
conducted with respect to a hospice program that is not
included on the list established under paragraph (5),''
after ``local survey agency, or''; and
(B) by inserting ``(or, in the case of a hospice
program that is included on the list established under
paragraph (5), not less frequently than once every 18
months)'' after ``36 months'';
(2) by redesignating paragraph (5) as paragraph (6);
(3) by inserting after paragraph (4) the following new
paragraph:
``(5) Hospice programs subject to increased survey
frequency.--
``(A) In general.--The Secretary shall establish a
list of hospice programs subject to increased survey
frequency under paragraph (1) in accordance with the
provisions of this paragraph.
``(B) Inclusion on list.--
``(i) In general.--The Secretary shall
include a hospice program on the list
established under subparagraph (A) if such
program is not participating in the special
focus program under subsection (b) and such
hospice program meets either of the following
criteria:
``(I) The program first submitted a
claim for an item or service under this
title during the 5-year period ending
on the date of the enactment of this
paragraph.
``(II) The program first submits a
claim for an item or service under this
title on or after such date of
enactment.
``(ii) Discretionary inclusion.--The
Secretary may include a hospice program on the
list established under subparagraph (A)--
``(I) if claims data submitted by
such program indicates that such
program is not providing the full scope
of hospice care services payable under
this title;
``(II) if the Secretary determines
that such program is an outlier with
respect to live discharges; or
``(III) for any other reason
determined appropriate by the
Secretary.
``(C) Removal from list.--The Secretary shall
remove a hospice program included in the list
established under subparagraph (A)--
``(i) if--
``(I) such program has been subject
to 2 surveys under this subsection
while included on such list; and
``(II) neither such survey resulted
in such program being cited for a
deficiency for failure to comply with a
condition of participation relating to
quality of care; or
``(ii) if such program is placed in the
special focus program established under
subsection (b).''; and
(4) in paragraph (6), as so redesignated, by striking
``each fiscal year (beginning with fiscal year 2022)'' and
inserting ``each of fiscal years 2022 through 2025, and of
$15,000,000 for fiscal year 2026 and for each subsequent fiscal
year,''.
(d) Prohibition on Payment for Failure To Meet Quality Data
Reporting Requirements.--Section 1814(i)(5) of the Social Security Act
(42 U.S.C. 1395f(i)(5)) is amended--
(1) in subparagraph (A)--
(A) in the header, by striking ``Reduction in
update for'';
(B) in clause (i)--
(i) in the header, by striking ``In
general'' and inserting ``Fiscal years 2014
through 2026'';
(ii) by inserting ``through fiscal year
2026'' after ``each subsequent fiscal year'';
and
(iii) by adding at the end the following
new sentence: ``The application of the
preceding sentence may result in the market
basket percentage increase under paragraph
(1)(C)(ii)(VII) or paragraph (1)(C)(iii), as
applicable, being less than 0.0 for a fiscal
year, and may result in payment rates under
this subsection for a fiscal year being less
than such payment rates for the preceding
fiscal year.''; and
(C) by amending clause (ii) to read as follows:
``(ii) Subsequent fiscal years.--For
purposes of fiscal year 2027 and each
subsequent fiscal year, no payment may be made
under this title to a hospice program that does
not submit data to the Secretary in accordance
with subparagraph (C)