I 

111TH CONGRESS 

1ST SESSION H. R. 3454 

To amend title XVIII of the Social Security Act to reform payments and 

coverage for hospice care under the Medicare Program. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 31, 2009 

Mr. SULLIVAN (for himself, Mr. BOREN, Mr. COLE, Mr. LUCAS, and Ms. 

FALLIN) 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 reform 

payments and coverage for hospice care under the Medicare Program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Hospice Re5 form and Savings Act of 2009’’. 


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1 SEC. 2. HOSPICE CARE PAYMENT AND COVERAGE RE2 FORMS. 

3 (a) RELIEF FROM DEMAND PAYMENTS.—Section 

4 1814(i)(2) of the Social Security Act (42 U.S.C. 

5 1395f(i)(2)) is amended— 

6 (1) in subparagraph (A), by inserting ‘‘(ending 

7 before November 1, 2009)’’ after ‘‘for an account 

8 year;’’; and 

9 (2) by adding at the end the following new sub10 paragraph: 

11 ‘‘(E) With respect to repayment demands based upon 

12 the application of this paragraph for an accounting year 

13 ending during the 4-year period ending on October 31, 

14 2009, recovery by the Secretary of such demands from a 

15 hospice program shall be subject to the following: 

16 ‘‘(i)(I) Subject to subclause (II), no such de17 mand to any hospice program shall exceed 10 per18 cent of the payments under this part to the program 

19 for the same time period covered by the demand. 

20 ‘‘(II) The aggregate reduction in repayment de21 mands under subclause (I) shall not exceed 

22 $400,000,000 and the Secretary shall reduce, in a 

23 pro-rata manner, the application of reductions under 

24 such subclause to the extent such reductions would 

25 otherwise exceed such limit. 


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1 ‘‘(III) Subclause (I) shall be applied taking into 

2 account principal amounts made on or before the 

3 date of the enactment of this subparagraph. 

4 ‘‘(ii) Upon request of a hospice program subject 

5 to the maximum demand under the limitation speci6 fied in clause (i), the Secretary shall allow the pro7 gram a period of 60 months from the date of de8 mand to repay such demand in installments. 

9 ‘‘(iii) The interest rate charged on any demand 

10 during the period specified in this clause may not 

11 exceed the effective rate established by the Secretary 

12 of the Treasury pursuant to section 3717(a) of title 

13 31, United States Code, as of the date of the de14 mand. 

15 Nothing in this subparagraph shall be construed to require 

16 the Secretary to return funds collected or repaid before 

17 the date of the enactment of this subparagraph.’’. 

18 (b) REALIGNMENT OF PAYMENT AMOUNTS.—Section 

19 1814(i)(1) of such Act (42 U.S.C. 1395f(i)(1)) is amend20 ed— 

21 (1) in subparagraph (B), by inserting ‘‘subject 

22 to subparagraph (D),’’ after ‘‘subparagraph (A)’’; 

23 (2) in subparagraph (C), by inserting ‘‘subject 

24 to subparagraph (D),’’ after ‘‘for a subsequent fiscal 

25 year,’’; and 


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1 (3) by adding at the end the following new sub2 paragraph: 

3 ‘‘(D)(i) In the case of hospice care (other than short4 term inpatient care) furnished on or after November 1, 

5 2009, with respect to an individual in a hospice election 

6 period (other than one of the first two 90-day periods for 

7 such individual under section 1812(d)(1)), the amount of 

8 payment otherwise established for such care shall be reduced by 121 9 ⁄2 percent. 

10 ‘‘(ii) In the case of routine home hospice care fur11 nished on or after November 1, 2009, during the first 5 

12 days of hospice care in an individual’s initial 90-day hos13 pice election period under section 1812(d)(1) and during 

14 the last 5 days of hospice care preceding (and including) 

15 the date of the beneficiary’s death, the amount of payment 

16 otherwise established for such care shall be increased by 

17 20 percent.’’. 

18 (c) LISTING OF TERMINAL ILLNESSES.—By not later 

19 than January 31, 2010, and for purposes of applying sec20 tion 1861(dd)(3)(A) of the Social Security Act (42 U.S.C. 

21 1395x(dd)(3)(A)), the Secretary of Health and Human 

22 Services shall issue evidence-based national coverage de23 terminations for life expectancies covering at least each 

24 of those terminal medical diagnoses currently covered by 


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1 Local Coverage Determinations promulgated by Medi2 care’s fiscal intermediaries. 

3 (d) DELAY IN PHASE OUT OF MEDICARE HOSPICE

4 BUDGET NEUTRALITY ADJUSTMENT FACTOR DURING

5 FISCAL YEARS 2010–2013 BASED UPON SAVINGS FROM

6 NATIONAL COVERAGE DETERMINATIONS.— 

7 (1) DETERMINATION OF SAVINGS.—The Sec8 retary of Health and Human Services shall annually 

9 determine, and report to Congress, the amount of 

10 the reductions in expenditures under title XVIII of 

11 the Social Security Act during fiscal years 2010 

12 through 2013 that results from the issuance of the 

13 national coverage determinations described in sub14 section (c) for hospice care. 

15 (2) RESTORATION OF MEDICARE HOSPICE

16 BUDGET NEUTRALITY ADJUSTMENT FACTOR.—Not17 withstanding any other provision of law, including 

18 the final rule published on August 10, 2008, 73 

19 Federal Register 46464 et seq., relating to Medicare 

20 Program; Hospice Wage Index for Fiscal Year 2009, 

21 the Secretary shall restore the application (and re22 duce the phase out) of the budget neutrality adjust23 ment factor in the Medicare hospice wage index for 

24 the fiscal years 2010 through 2013 in such manner 

25 as the Secretary estimates will result in an aggreVerDate Nov 24 2008 20:48 Aug 10, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3454.IH H3454

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1 gate increase in expenditures under title XVIII of 

2 the Social Security Act equivalent to the aggregate 

3 reductions in expenditures determined under para4 graph (1) for such period. 

Æ 


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