WHAT CONGRESS CAN DO TO
PRESERVE AND PROTECT THE MEDICARE HOSPICE BENEFIT
– HOUSE –
Support The Hospice Care Access Improvement Act of 2015 [H.R. 3037]. In the FY 2016 Notice of Proposed
Rulemaking (NPRM), CMS proposes a new two-tiered payment system for hospice for the routine home care
rate: a higher payment rate for a patient’s 1st-60th days in hospice, and a lower rate for days 61+ of care.
NHPCO is supportive of the proposal and believes that payment of a higher rate during the first 60 days of care
reflects the service intensity identified by CMS and its contractors in claims data. However, NHPCO and many
providers have significant concerns about the ability of CMS, the MACs, and hospices to be able to put in place
and test the system changes, and conduct the necessary education and training in order for these changes to
be implemented on October 1, 2015, without considerable problems.
The Hospice Care Access Improvement Act of 2015 calls for a 1 year demonstration project to test any
payment methodology reform proposed by CMS. CMS shall select one Medicare Administrative Contractor
(“MAC”) to conduct the demonstration program with all hospices under that MAC’s jurisdiction during the 1
year period. No later than 6 months after the completion of the demonstration program the Secretary shall
submit to Congress a report containing the results of the evaluation, together with recommendations for such
legislation and administrative action as the Secretary determines appropriate.
This legislation also contains a number of program integrity provisions long-supported by the hospice
community, including:
• Expanding CMS medical review for providers who have concerning results on multiple data points.
• Requiring programs to establish interventions to reduce likelihood of ER visits and hospital admissions
for patients identified to be at high risk for readmissions, particularly in the first week of hospice
service.
• Expanding the pre-hospice evaluation code to include additional clinical staff from the hospice
interdisciplinary team.
• Requiring, as part of a hospital discharge planning process, that any patient referred for possible
admission to hospice be informed of all Medicare certified hospice programs in the service area who
ask to be included, as well as noting those with whom the hospital has an ownership relationship.
The Hospice Care Access Improvement Act is led by Representatives Reed (NY-23) and Thompson (CA-5). Please
contact these offices to be added as a cosponsor.
For additional information, please contact info@nhpcohan.org.
WHAT CONGRESS CAN DO TO
PRESERVE AND PROTECT THE MEDICARE HOSPICE BENEFIT
AND SUPPORT AMERICANS WITH ADVANCED ILLNESS
– SENATE –
Join Roberts/Warner Sign-on Letter Asking CMS to Test Hospice Payment Changes. In the FY 2017 Notice of
Proposed Rulemaking (NPRM), CMS proposes a new two-tiered payment system for hospice for the routine
home care rate: a higher payment rate for a patient’s 1st-60th days in hospice, and a lower rate for days 61+
of care. NHPCO is supportive of the proposal and believes that payment of a higher rate during the first 60
days of care reflects the service intensity identified by CMS and its contractors in claims data. However,
NHPCO and many providers have significant concerns about the ability of CMS, the MACs, and hospices to be
able to put in place and test the system changes, and conduct the necessary education and training in order
for these changes to be implemented on October 1, 2015 without considerable problems.
Senators Roberts (R-KS) and Warner (D-VA) agree with the concerns of the hospice community stated above.
They are circulating a letter addressed to CMS Acting Administrator Andrew Slavitt urging CMS to refrain from
implementing any changes to the hospice payment methodology until CMS has adequately tested all of the
system changes to ensure that claims will be processed and paid accurately and in a timely manner, and that
beneficiary access to quality hospice care is not adversely affected.
The letter is expected to be open through Wednesday, July, 22. Please contact staff in the offices of Senators
Roberts (R-KS) and Warner (D-VA) to be added to the letter.
Support the Care Planning Act [S 1549]. The Care Planning Act is designed to give people with serious illness
the freedom to make more informed choices about their care, and the power to have those choices honored.
Specifically, the Care Planning Act (1) establishes a new Medicare benefit called Planning Services for those
with advanced illness, allowing for a team-based approach of care planning discussions with doctors, nurses,
and other healthcare professionals; (2) creates a pilot program for Advanced Illness Coordination Services to
allow for home-based support of patients with multiple and complex chronic conditions; and (3) directs the
Secretary of HHS to develop quality metrics, public educational efforts, and resource development on
advance care planning.
The Care Planning Act is sponsored by Senators Isakson (R-GA) and Warner (D-VA). Please contact these
offices to be added as a cosponsor.
For additional information, please contact info@nhpcohan.org.