PCHETA Reintroduced in Congress

The 115th Congress is busy! Nomination hearings of all stripes, healthcare reform debates, espionage investigations, and legislation being introduced! Today, we’re excited about legislation.

You may remember that the Medicare Patient Access to Hospice Act (H.R. 1284) was reintroduced earlier this month. Last week, the Palliative Care and Hospice Education and Training Act (S. 693/ H.R. 1676) was reintroduced in both the Senate and House yesterday! Senators Baldwin (D-WI) and Capito (R-WV) introduced the bill in the Senate, and Congressman Engel (D, NY-16) reintroduced the legislation in the House, with Representatives Reed (R, NY-23) and Carter (GA-1) joining as original cosponsors. NHPCO is proud to support this legislation.

PCHETA will ensure that an adequate, well-trained palliative care workforce is available for individuals with serious illness and at the end of life. Among other initiatives, this legislation will:

  • fund programs to provide clinical palliative medicine training in a variety of settings, including hospice;
  • establish a program to enable hospice and palliative physicians to train teams of interdisciplinary healthcare professionals in palliative and hospice care techniques; and
  • expand the types of professionals trained to provide hospice care, including nurses and clinical social workers.

Here’s the part where you come in. Ask your Senators and Representative to cosponsor this important biparitsan legislation. We have developed an email for you to send, but we highly encourage you to make personalized edits–have you seen the shortage of palliative care providers first hand? Do you have a story about the benefits palliative care provided a patient? These edits raise the importance of your message on Capitol Hill. All you have to do to get started is click the “Take Action” button below!

Medicare Patient Access to Hospice Act Introduced!

Earlier this month, Congresswoman Lynn Jenkins (R, KS-2) and Congressman Mike Thompson (D, CA-5) introduced the Medicare Patient Access to Hospice Act (H.R. 1284). In rural and other medically under-served communities, a physician assistant (PA) may be the only healthcare professional in the community. Current Medicare rules do not allow PAs to serve as the hospice attending physician or perform other functions that are otherwise consistent with their scope of practice. Patients who receive their primary care from a PA must give up that provider when they elect hospice care. This can cause significant stress for patients at an already difficult time. H.R. 1284 would correct this problem and allow physician assistants to serve as attending physicians to hospice patients.

NHPCO supports this bipartisan legislation, and we hope you take action! Send an email to your Member of Congress and ask to cosponsor this legislation by clicking the “Take Action” button below!  A template email is provided for you, but we encourage you to personalize it for added impact! 


MedPAC Report to Congress, March 2017 Edition

While millions of people across the Northeast are digging out from a late-winter snow storm, health policy professionals are digging into the annual Medicare Payment Advisory Commission’s (MedPAC) “Report to the Congress: Medicare Payment Policy.” Released every March, this report reviews payment policy across a variety of Medicare providers, including hospice.

The hospice chapter begins with an updated snapshot of the hospice industry. According to MedPAC, 1.38 million Medicare beneficiaries (or almost 49% of Medicare decedents) received hospice care in 2015 from 4,200 hospice providers. In that year, Medicare spent $15.9 billion on hospice care, up from $15.1 billion in 2014. However, Medicare spending on hospice care constituted less than 3% of overall Medicare spending.

This year’s chapter on hospice reflects the recommendation the Commission approved in January: “The Congress should eliminate the update to the hospice payment rates for fiscal year 2018.”  Don’t get alarmed just yet. Here are a few things to keep in mind:

  1. MedPAC has made this same recommendation to Congress for the following fiscal year since at least 2013.
  2. Congress must take action for a MedPAC recommendation to be implemented. Congress has not taken action to implement this recommendation in recent years.
  3. CMS will likely be bound by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), which mandated that the hospice payment update for FY 18 is limited to 1 percent, as we have reported in the past.
  4. Additional information about FY 2018 rates will be made available when CMS issues its annual hospice wage index update later this spring.

And you may remember that Congress has been rather busy lately. While Congress will certainly review the MedPAC report, they have many other priorities to address in the immediate future. HAN will continue to monitor any possible Congressional action based on MedPAC’s recommendation. If there are any developments, you can be sure to find updates on this blog!


Seema Verma Goes to Washington

Seema Verma, the designee for Administrator of the Centers for Medicare and Medicaid Services (CMS), appeared before the Senate Finance Committee yesterday for her confirmation hearing (watch HAN’s What to Expect in 2017 video for more information about Verma!). Like most confirmation hearings, topics were wide-ranging, from electronic health records, Medicare Advantage, to rural and critical access hospital issues.

Verma’s answers, as is the case for most nominees during confirmation hearings, were somewhat vague. Nominees do not want to be pinned to specific policy options until they can find their new offices. It was clear that the contractor who engineered Healthy Indiana 2.0, Indiana’s Medicaid expansion plan, was more comfortable discussing Medicaid topics than Medicare. Several Medicare policy areas she did speak strongly about were preventing fraud and abusing being a “top priority” for the Medicare program, that she does not support turning Medicare into a voucher program, and including rural providers in the development of policies and regulations. Throughout the hearing, Verma repeated several themes that define her philosophy of healthcare policy that would carry over to her role leading CMS:

“Patients and their doctors should be making decisions about their health care, not the federal government.”

“I will work with the CMS team to ensure that the programs are focused on achieving positive outcomes and to improve the health of the people we serve.”

“I will work toward policies that foster patient-centered care approaches that increase competition, quality, and access while driving down costs.”

We’ll keep you posted on Verma’s progress through her nomination!

Do Rules No Longer Apply?

Update, February 2, 2017: On Wednesday, Senate Finance Committee democrats once again staged a boycott of the votes for Congressman Price (HHS nominee) and Steve Mnuchin (Treasury nominee). Committee Chairman Orrin Hatch (R-Utah) suspended committee rules, so the 12 republicans present could vote on the nominees. Both were approved by the Republicans and will now be considered by the entire Senate. This morning, Senator John Barrosso (R-WY), Chairman of the Environment and Public Works Committee, also suspended committee rules to bypass a Democrat boycott of Environmental Protection Agency nominee Scott Pruitt. Pruitt was approved by the committee members in attendance, 11-0.

Who knew C-SPAN could be this exciting?! This morning, the Senate Finance Committee‘s Democrat members boycotted votes on President Trump’s nominee for Secretary of the Treasury, Steve Mnuchin, and Secretary of Health of Human Services (HHS), Congressman Tom Price. Only 1 Democratic Senator on the Committee needed to be present for the Committee to move forward with votes today. However, Democrats refused to attend the session because they want more time to further investigate ethics concerns they have on both nominees.  Under the Committee’s rules, a quorum—a simple majority that includes one member of the minority party—is required to hold a vote on a nominee. The Republicans stated they will rescheduled both votes.

However, a Committee does not need to vote to move any cabinet nominee to the Senate floor for a vote. If votes continue to be blocked by Senate Finance Democrats, the nominees may move down different routes toward confirmation. If Mnuchin and/or Rep. Price are not voted on by the Committee, the Senate may vote to move the nominations directly to the full Senate floor. Another option for Republican Committee members is to bypass Committee rules and vote to advance the appointees without any Democrats present.

Boycotts like today’s are uncommon, but not new. In 2013, Republicans in the Committee on Environment and Public Works staged a boycott of Gina McCarthy, President Obama’s appointee to lead the Environmental Protection Agency. In 2003, Republicans in the House Ways and Means Committee tried to pass a pension bill, but every Democrat on the committee walked out of the hearing.

But wait…there’s more! At the time of this posting, President Trump is expected to announce his nominee to the Supreme Court this evening. If cabinet nominations are any indication, the President’s candidate for the Supreme Court will face a long, unpredictable confirmation process. Unlike the cabinet nominees, who need only 51 votes to be confirmed by the Senate, Supreme Court justices still need 60 votes to be confirmed. Some Republicans have even suggested that, if Democrats attempt to filibuster the designated justice on the Senate floor, the “nuclear option” could be used. The “nuclear option” refers to changing Senate procedural rules to end debate (and thereby a filibuster) by 51 votes instead of the usual 60. It’s too soon to tell how the Supreme Court nominee will be received and how partisan the challenge may become.

And we’re 29 days into the 115th Congress. It’s hard not to ask, do rules no longer apply?

It is unclear how the nomination process for Mnuchin or Congressman Price will move forward. Despite the delay of Congressman Price’s confirmation, the work of HHS and CMS continues. We continue to monitor CMS activity and any potential changes to the Medicare Hospice Benefit. Stay tuned for additional updates on the confirmation progress of Congressman Price.