A couple of provisions in a landmark piece of hospice legislation, still in draft form, are cause for concern among hospice stakeholders. Providers, however, generally believe that, if passed, the bill would modernize the Medicare hospice benefit with much-needed program integrity measures and payment reforms.
One notable concern is the so-called “hospice addendum provision” in the Hospice CARE Act, which would require hospices to provide patients with information related to non-covered services. LeadingAge recommended this provision be struck from the bill as many hospices might find it unnecessary. The NAHC-NHPCO Alliance requested more information and did not give an official stance for or against it.
Overall, the measure has received a positive reaction from providers.
“It’s an all-hands-on-deck moment,” Mollie Gurian, vice president of home- and community-based policy at LeadingAge, told McKnight’s in an interview Monday. “I think it’s a huge opportunity.”
Friday was the deadline to submit feedback, as requested by sponsor Rep. Earl Blumenauer (D-OR), on the draft version of his Hospice Care Accountability, Reform and Enforcement (CARE) Act. Among its provisions, the bill would impose a moratorium on new hospice enrollment, increase survey frequency, demand greater ownership transparency, and create new payment mechanisms for respite care and various specialized services.
Many of those items represent meaningful change to the Medicare hospice program, according to LeadingAge. Some opportunities still remain to workshop and modify the drafted provision to have the best possible effect, however.
“We were generally pretty supportive of the intent of what they’re trying to do and the approach that they took to try to do it,” Gurian said. “I think there were some places where the idea … just isn’t going to work the way they thought, and I think that’s the kind of feedback they’re going to be happy to receive.”
Another industry concern is the “Independence of Attending Physician” provision proposed in the Hospice CARE Act, which would prohibit certain physicians from certifying terminal illness as a patient’s attending physician. Though the provision is intended to eliminate financial conflicts of interests, Gurian noted that it could be altered to be more effective.
The NAHC-NHPCO Alliance, formerly the National Association for Home Care & Hospice and the National Hospice and Palliative Care Organization, submitted its own feedback on the Hospice CARE Act. The Alliance opposed the Independence of Attending Physician provision and recommended that it be removed from the bill.
“The NAHC-NHPCO Alliance recognizes the need for increased program integrity to combat bad actors while striving to ensure that access to care is not negatively impacted or that undue burdens are placed on quality providers,” the Alliance said Friday in a statement.
Blumenauer has promised to review all of the feedback on the Hospice CARE Act before eventually submitting a revised draft. Although this process is expected to take some time, providers should not have to wait too long to see the next iteration of the bill. Blumenauer has announced that he will not seek reelection after his current term, and that the Hospice CARE Act is important to his legacy.
“We do anticipate that this bill will be introduced sometime this fall,” Gurian said. “That doesn’t mean that [this is] the final version that will hopefully someday pass, but this is a legacy of his and he wants the chance to introduce it under his name — which we can all understand and want him to be able to do. He has been a great champion of ours.”
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