Rep. Earl Blumenauer (D-Oregon) recently announced a draft bill that, if enacted, would bring unprecedented reforms to hospice payment and oversight. The Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act addresses various challenges in the hospice industry, including staffing, quality of long-term care, and fraudulent activities.
Increasing Hospice Offerings
As more skilled nursing operators expand their hospice offerings, the draft bill could significantly impact the industry. Many operators are launching their hospice businesses or partnering with existing hospice providers to serve their patients better.
Transitional Inpatient Respite Care
One notable proposal in the draft bill is to allow transitional inpatient respite care for up to 15 days for patients transitioning from hospital to hospice care. This change aims to give families more time to plan the best next steps for their loved ones, whether moving to a nursing home, assisted living, or preparing the home environment for hospice care.
Need for Transitional Care
“When people are coming on the benefit in that moment of crisis, they don’t necessarily have a plan,” said Mollie Gurian, Vice President of Home-Based and HCBS Policy at LeadingAge. “This would give families more time to figure out the best next step.”
National Moratorium on New Enrollments
The Hospice CARE Act proposes a temporary, national moratorium on enrolling new hospices into Medicare. This measure aims to curb fraudulent activities among newly established providers, particularly in states like California, Arizona, Texas, and Nevada.
Oversight and Accountability
“We would stop new enrollments until we have the chance to work this through,” Blumenauer said. The bill also seeks to address issues with the per diem payment system, potentially reducing daily rates and adding a per-visit payment for clinical services to ensure appropriate care delivery.
Higher-Acuity Care
The bill includes provisions for a payment add-on to support the delivery of higher-acuity palliative services that are challenging to help within the current payment structure. This would cover dialysis, chemotherapy, radiation, and blood transfusions.
Quality Data Submission
The proposed legislation would prohibit payment to hospice programs without submitting required quality data. About 20% of hospice programs still need to comply with quality data submission requirements despite facing a 4% payment penalty.
Role of Nurse Practitioners
The bill would also allow nurse practitioners to certify patients for hospice care, broadening the scope of healthcare professionals who can facilitate hospice transitions.
Encouraging Industry Input
Blumenauer has encouraged hospice providers to contact his office to express their views and needs regarding the reform of hospice care, oversight, and payment. “This is an opportunity to do something in this Congress that is concrete, specific, that will save money and improve the quality of care for some of our most vulnerable people,” he said.
New Levels of Respite Care
The legislation proposes creating new levels of respite care. It would allow for five inpatient respite days per election period and introduce a short-term, home-respite level of care for up to five days during an election period.
Industry Support and Concerns
Ben Marcantonio, COO and interim CEO of the National Hospice and Palliative Care Organization (NHPCO), supported Blumenauer’s efforts. “We are grateful to him for his dedicated effort to advance serious illness and end-of-life care and look forward to providing feedback on the Hospice CARE Act,” he said.
Balancing Reform and Practicality
Bill Dombi, President of the National Association for Home Care and Hospice (NAHC), emphasized balancing reforms with practical implementation. “We want to make sure the proposed policies don’t unduly burden hospices following the rules and delivering quality care,” he said. “We will work with our members and partners to gather detailed feedback on the draft.”
Collaborative Efforts
Each nation’s four largest hospice industry groups—NHPCO, NAHC, LeadingAge, and the National Partnership for Healthcare and Hospice Innovation (NPHI)—have committed to providing feedback to help shape the legislation as it progresses through Congress. NPHI CEO Tom Koutsoumpas praised Blumenauer’s efforts, stating, “We look forward to working closely with the Congressman, his staff, and committee staff to provide feedback on this detailed and thoughtful proposal.”
The Hospice CARE Act represents a significant step towards improving hospice care, oversight, and payment structures in the United States. If enacted, the bill would introduce essential reforms to enhance care quality and accountability while addressing industry challenges such as staffing shortages and fraudulent activities. As the bill progresses, collaboration between lawmakers and industry stakeholders will be crucial to ensure that the reforms are practical and effective in improving end-of-life care for patients and their families.
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