PRIA, Government Policy, Made Personal

Summary

Medicare-certified hospice programs must be inspected at least once every 36 months by a state or local survey agency or by an approved accrediting group chosen by the Secretary (the head of the Centers for Medicare & Medicaid Services). Those agencies and accrediting groups must send the inspection reports, any enforcement actions, and other required information to the Secretary. For accreditation surveys done on or after October 1, 2021, the reports must include Form CMS‑2567 (or its successor). The Secretary must put this information on the CMS website by October 1, 2022, in a way people can easily find and search, and keep it updated. States and the Secretary must work to make survey results less inconsistent between surveyors. Surveys done by more than one person on or after October 1, 2021 must be a team of different professionals that includes a registered nurse. Team members may not have worked for or consulted to the hospice in the last 2 years or have a personal or family financial interest in it. The Secretary must provide training and testing for all surveyors by October 1, 2021. The Secretary must transfer $10,000,000 each fiscal year starting in 2022 from the Federal Hospital Insurance Trust Fund to the CMS Program Management Account to carry out these duties. The Secretary must run a special focus program for hospices that have seriously failed to meet rules and must survey those hospices at least every 6 months. If an inspection shows a hospice is out of compliance and people’s health or safety is in immediate danger, the Secretary must act right away to remove the danger, fix the problems, or end the hospice’s Medicare certification, and may use other remedies. If problems do not pose immediate danger, the Secretary can use corrective remedies for up to 6 months instead of ending certification; if problems remain after that, certification must end. The Secretary can also fine past days of noncompliance. The hospice may keep getting Medicare payments for up to 6 months only if the state prefers an alternative, the hospice submits and the Secretary approves a corrective plan, and the hospice agrees to repay payments if it does not follow the plan. By October 1, 2022 the Secretary must set up a range of remedies and appeal rules and spell out how and when each remedy (including fine amounts and increasing penalties for repeated problems) will be used. Remedies can include civil money penalties up to $10,000 per day, suspension of payments, and appointment of temporary managers. Parts of the penalty process follow existing rules for civil money penalties, and some penalty money may be used for hospice training or other beneficiary benefits. Payment suspensions end when the hospice is substantially compliant, and temporary management ends only when the Secretary is satisfied the hospice can stay in compliance. These federal remedies do not replace other state or legal actions.

Title 42, §1395i–6

The Public Health and Welfare, Source: USLM XML via OLRC

(a)(1)Any entity that is certified as a hospice program (as defined in section 1395x(dd)(2) of this title) shall be subject to a standard survey by an appropriate State or local survey agency, or an approved accreditation agency, as determined by the Secretary, not less frequently than once every 36 months.

(2)(A)(i)Each State or local survey agency, and each national accreditation body with respect to which the Secretary has made a finding under section 1395bb(a) of this title respecting the accreditation of a hospice program by such body, shall submit, in a form and manner, and at a time, specified by the Secretary for purposes of this paragraph, information respecting any survey or certification made with respect to a hospice program by such survey agency or body, as applicable. Such information shall include any inspection report made by such survey agency or body with respect to such survey or certification, any enforcement actions taken as a result of such survey or certification, and any other information determined appropriate by the Secretary.

(ii)With respect to a survey under this subsection carried out by a national accreditation body described in clause (i) on or after October 1, 2021, information described in such clause shall include Form CMS-2567 (or a successor form), along with such additional information determined appropriate by such body.

(B)Beginning not later than October 1, 2022, the Secretary shall publish the information submitted under subparagraph (A) on the public website of the Centers for Medicare & Medicaid Services in a manner that is prominent, easily accessible, readily understandable, and searchable. The Secretary shall provide for the timely update of such information so published.

(3)Each State and the Secretary shall implement programs to measure and reduce inconsistency in the application of survey results among surveyors.

(4)(A)In the case of a survey conducted under this subsection on or after October 1, 2021, by more than 1 individual, such survey shall be conducted by a multidisciplinary team of professionals (including a registered professional nurse).

(B)Beginning October 1, 2021, a State may not use as a member of a survey team under this subsection an individual who is serving (or has served within the previous 2 years) as a member of the staff of, or as a consultant to, the program surveyed respecting compliance with the requirements of section 1395x(dd) of this title or who has a personal or familial financial interest in the program being surveyed.

(C)The Secretary shall provide, not later than October 1, 2021, for the comprehensive training of State and Federal surveyors, and any surveyor employed by a national accreditation body described in paragraph (2)(A)(i), in the conduct of surveys under this subsection, including training with respect to the review of written plans for providing hospice care (as described in section 1395f(a)(7)(B) of this title). 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 Secretary.

(5)The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1395i of this title to the Centers for Medicare & Medicaid Services Program Management Account, of $10,000,000 for each fiscal year (beginning with fiscal year 2022) for purposes of carrying out this subsection and subsection (b). Sums so transferred shall remain available until expended. Any transfer pursuant to this paragraph shall be in addition to any transfer pursuant to section 3(a)(2) of the Improving Medicare Post-Acute Care Transformation Act of 2014.

(b)(1)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 chapter.

(2)Under such special focus program, the Secretary shall conduct surveys of each hospice program in the special focus program not less than once every 6 months.

(c)(1)If the Secretary determines on the basis of a standard survey or otherwise that a hospice program that is certified for participation under this subchapter is no longer in compliance with the requirements specified in section 1395x(dd) of this title and determines that the deficiencies involved immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services, the Secretary shall take immediate action to ensure the removal of the jeopardy and correction of the deficiencies or terminate the certification of the program, and may provide, in addition, for 1 or more of the other remedies described in paragraph (5)(B).

(2)If the Secretary determines on the basis of a standard survey or otherwise that a hospice program that is certified for participation under this subchapter is no longer in compliance with the requirements specified in section 1395x(dd) of this title and determines that the deficiencies involved do not immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services, the Secretary may (for a period not to exceed 6 months) impose remedies developed pursuant to paragraph (5)(A), in lieu of terminating the certification of the program. If, after such a period of remedies, the program is still no longer in compliance with such requirements, the Secretary shall terminate the certification of the program.

(3)If the Secretary determines that a hospice program that is certified for participation under this subchapter is in compliance with the requirements specified in section 1395x(dd) of this title but, as of a previous period, did not meet such requirements, the Secretary may provide for a civil money penalty under paragraph (5)(B)(i) for the days in which the Secretary finds that the program was not in compliance with such requirements.

(4)The Secretary may continue payments under this subchapter with respect to a hospice program not in compliance with the requirements specified in section 1395x(dd) of this title over a period of not longer than 6 months, if—

(A)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 program;

(B)the program has submitted a plan and timetable for corrective action to the Secretary for approval and the Secretary approves the plan of corrective action; and

(C)the program agrees to repay to the Federal Government payments received under this subchapter during such period if the corrective action is not taken in accordance with the approved plan and timetable.

(5)(A)(i)Not later than October 1, 2022, the Secretary shall develop and implement—

(I)a range of remedies to apply to hospice programs under the conditions described in paragraphs (1) through (4); and

(II)appropriate procedures for appealing determinations relating to the imposition of such remedies.

(ii)Not later than October 1, 2022, the Secretary shall develop and implement specific procedures with respect to the conditions under which each of the remedies developed under clause (i) is to be applied, including the amount of any fines and the severity of each of these remedies. 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 deficiencies.

(B)The remedies specified in this subparagraph are the following:

(i)Civil money penalties in an amount not to exceed $10,000 for each day of noncompliance by a hospice program with the requirements specified in section 1395x(dd) of this title.

(ii)Suspension of all or part of the payments to which a hospice program would otherwise be entitled under this subchapter 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 paragraphs (1) and (2).

(iii)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 requirements.

(C)(i)(I)Subject to subclause (II), the provisions of section 1320a–7a of this title (other than subsections (a) and (b)) shall apply to a civil money penalty under this subsection in the same manner as such provisions apply to a penalty or proceeding under section 1320a–7a(a) of this title.

(II)The Secretary may provide that any portion of civil money penalties collected under this subsection may be used to support activities that benefit individuals receiving hospice care, including education and training programs to ensure hospice program compliance with the requirements of section 1395x(dd) of this title.

(ii)A finding to suspend payment under subparagraph (B)(ii) shall terminate when the Secretary finds that the program is in substantial compliance with all requirements of section 1395x(dd) of this title.

(iii)The temporary management under subparagraph (B)(iii) 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 subparagraph.

(D)The remedies developed under subparagraph (A) are in addition to sanctions otherwise available under State or Federal law and shall not be construed as limiting other remedies, including any remedy available to an individual at common law.

Editorial Notes

References in Text

section 3(a)(2) of the Improving Medicare Post-Acute Care Transformation Act of 2014, referred to in subsec. (a)(5), means section 3(a)(2) of Pub. L. 113–185, Oct. 6, 2014, 128 Stat. 1968, which is not classified to the Code.

§1395i–6 Hospice Program Survey and Enforcement Procedures

Summary

Title 42, §1395i–6

Notes & Related Subsidiaries

Editorial Notes

References in Text

Citations & Metadata