To amend title XVIII of the Social Security Act to reform payments and coverage for hospice care under the Medicare Program.

Summary: Medicare Hospice Reform and Savings Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act to revise payments and coverage for hospice care under the Medicare program.

Prescribes conditions for recovery by the Secretary of Health and Human Services (HHS) of repayment demands from a hospice program for any accounting year during the four-year period ending on October 31, 2009.

Requires the Secretary to issue evidence-based national coverage determinations for life expectancies covering at least each of those terminal medical diagnoses currently covered by Local Coverage Determinations promulgated by Medicare's fiscal intermediaries.

Directs the Secretary to restore the application (and reduce the phase out) of the budget neutrality adjustment factor in the Medicare hospice wage index for FY2010-FY2013 in a manner that will result in an aggregate increase in Medicare expenditures equivalent to the aggregate reductions in expenditures resulting from the issuance of the national coverage determinations.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Hospice Reform and Savings 
Act of 2009''.

SEC. 2. HOSPICE CARE PAYMENT AND COVERAGE REFORMS.

    (a) Relief From Demand Payments.--Section 1814(i)(2) of the Social 
Security Act (42 U.S.C. 1395f(i)(2)) is amended--
            (1) in subparagraph (A), by inserting ``(ending before 
        November 1, 2009)'' after ``for an account year;''; and
            (2) by adding at the end the following new subparagraph:
    ``(E) With respect to repayment demands based upon the application 
of this paragraph for an accounting year ending during the 4-year 
period ending on October 31, 2009, recovery by the Secretary of such 
demands from a hospice program shall be subject to the following:
            ``(i)(I) Subject to subclause (II), no such demand to any 
        hospice program shall exceed 10 percent of the payments under 
        this part to the program for the same time period covered by 
        the demand.
            ``(II) The aggregate reduction in repayment demands under 
        subclause (I) shall not exceed $400,000,000 and the Secretary 
        shall reduce, in a pro-rata manner, the application of 
        reductions under such subclause to the extent such reductions 
        would otherwise exceed such limit.
            ``(III) Subclause (I) shall be applied taking into account 
        principal amounts made on or before the date of the enactment 
        of this subparagraph.
            ``(ii) Upon request of a hospice program subject to the 
        maximum demand under the limitation specified in clause (i), 
        the Secretary shall allow the program a period of 60 months 
        from the date of demand to repay such demand in installments.
            ``(iii) The interest rate charged on any demand during the 
        period specified in this clause may not exceed the effective 
        rate established by the Secretary of the Treasury pursuant to 
        section 3717(a) of title 31, United States Code, as of the date 
        of the demand.
Nothing in this subparagraph shall be construed to require the 
Secretary to return funds collected or repaid before the date of the 
enactment of this subparagraph.''.
    (b) Realignment of Payment Amounts.--Section 1814(i)(1) of such Act 
(42 U.S.C. 1395f(i)(1)) is amended--
            (1) in subparagraph (B), by inserting ``subject to 
        subparagraph (D),'' after ``subparagraph (A)'';
            (2) in subparagraph (C), by inserting ``subject to 
        subparagraph (D),'' after ``for a subsequent fiscal year,''; 
        and
            (3) by adding at the end the following new subparagraph:
    ``(D)(i) In the case of hospice care (other than short-term 
inpatient care) furnished on or after November 1, 2009, with respect to 
an individual in a hospice election period (other than one of the first 
two 90-day periods for such individual under section 1812(d)(1)), the 
amount of payment otherwise established for such care shall be reduced 
by 12\1/2\ percent.
    ``(ii) In the case of routine home hospice care furnished on or 
after November 1, 2009, during the first 5 days of hospice care in an 
individual's initial 90-day hospice election period under section 
1812(d)(1) and during the last 5 days of hospice care preceding (and 
including) the date of the beneficiary's death, the amount of payment 
otherwise established for such care shall be increased by 20 
percent.''.
    (c) Listing of Terminal Illnesses.--By not later than January 31, 
2010, and for purposes of applying section 1861(dd)(3)(A) of the Social 
Security Act (42 U.S.C. 1395x(dd)(3)(A)), the Secretary of Health and 
Human Services shall issue evidence-based national coverage 
determinations for life expectancies covering at least each of those 
terminal medical diagnoses currently covered by Local Coverage 
Determinations promulgated by Medicare's fiscal intermediaries.
    (d) Delay in Phase Out of Medicare Hospice Budget Neutrality 
Adjustment Factor During Fiscal Years 2010-2013 Based Upon Savings From 
National Coverage Determinations.--
            (1) Determination of savings.--The Secretary of Health and 
        Human Services shall annually determine, and report to 
        Congress, the amount of the reductions in expenditures under 
        title XVIII of the Social Security Act during fiscal years 2010 
        through 2013 that results from the issuance of the national 
        coverage determinations described in subsection (c) for hospice 
        care.
            (2) Restoration of medicare hospice budget neutrality 
        adjustment factor.--Notwithstanding any other provision of law, 
        including the final rule published on August 10, 2008, 73 
        Federal Register 46464 et seq., relating to Medicare Program; 
        Hospice Wage Index for Fiscal Year 2009, the Secretary shall 
        restore the application (and reduce the phase out) of the 
        budget neutrality adjustment factor in the Medicare hospice 
        wage index for the fiscal years 2010 through 2013 in such 
        manner as the Secretary estimates will result in an aggregate 
        increase in expenditures under title XVIII of the Social 
        Security Act equivalent to the aggregate reductions in 
        expenditures determined under paragraph (1) for such period.