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 Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction 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 Medi-
care Program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Hospice Re-
form and Savings Act of 2009’’. 
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SEC. 2. HOSPICE CARE PAYMENT AND COVERAGE RE-
FORMS. 
(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 sub-
paragraph: 
‘‘(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 de-
mand to any hospice program shall exceed 10 per-
cent of the payments under this part to the program 
for the same time period covered by the demand. 
‘‘(II) The aggregate reduction in repayment de-
mands 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. 
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‘‘(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 speci-
fied in clause (i), the Secretary shall allow the pro-
gram a period of 60 months from the date of de-
mand 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 de-
mand. 
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 amend-
ed— 
(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 
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(3) by adding at the end the following new sub-
paragraph: 
‘‘(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 re-
duced by 121⁄2 percent. 
‘‘(ii) In the case of routine home hospice care fur-
nished on or after November 1, 2009, during the first 5 
days of hospice care in an individual’s initial 90-day hos-
pice 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 sec-
tion 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 de-
terminations for life expectancies covering at least each 
of those terminal medical diagnoses currently covered by 
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Local Coverage Determinations promulgated by Medi-
care’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 Sec-
retary 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 sub-
section (c) for hospice care. 
(2) RESTORATION
OF
MEDICARE
HOSPICE 
BUDGET NEUTRALITY ADJUSTMENT FACTOR.—Not-
withstanding 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 re-
duce the phase out) of the budget neutrality adjust-
ment 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 aggre-
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gate increase in expenditures under title XVIII of 
the Social Security Act equivalent to the aggregate 
reductions in expenditures determined under para-
graph (1) for such period. 
Æ 
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