I 111th CONGRESS 1st Session H. R. 3454 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.

Short title

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

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 121/2 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.