Required Workaround for Hospices Submitting Routine Home Care (RHC) and Service Intensity Add-On (SIA) Payments at the End of Life

CMS recently issued SE17014 (PDF) to address hospice payment errors after the implementation of the January 1, 2016 hospice payment reform payment changes. They include payment errors for the two tiers of routine home care (RHC) and the service intensity add-on (SIA).

NHPCO has advocated on behalf of hospice providers to ensure that the guidance is clear and that the questions about how to proceed with this adjustment are answered.  As we continue to be in dialogue with CMS and the MACs on this issue, there may be additional clarifications.  NHPCO will immediately pass along any additional clarifications to NHPCO provider members as the information becomes available.

The following issues are covered in SE17014:

  1. History of the issue
  2. Credit balance reports
  3. Submitting adjustment claims now
  4. Using the Remarks field
  5. Timely filing deadline issues
  6. When to wait to submit adjustments
  7. Workaround for claims with a transfer in the benefit period

For additional questions, please contact your Medicare Administrative Contractor or

Members will find the full Regulatory Alert available on the NHPCO Regulatory Center online.

Being a Hospice Advocate

Today I thought I’d share an article written by one of my colleagues at NHPCO, Cassius Harris. Cassius has been an employee of the NHPCO Solutions Center for over nine years, assisting NHPCO Members and the general public with their questions about hospice. Here, he personalizes the experience of what being a hospice advocate means to him: 

As preparations for the summer Advocacy Intensive fall into place, NHPCO staff member Cassius Harris shares thoughts about the ways he advocates for hospice and palliative care in his daily work on the Solutions Center team.

Working in the NHPCO Solutions Center and supporting Infoline has taught me a great deal about the hospice field. From assisting NHPCO members to educating consumers, I have become quite knowledgeable about the hospice community and the many benefits that hospice and palliative care offer to patients and family caregivers. More importantly, working here has made me realize that I have become more than an NHPCO employee but something else – a hospice advocate.

Author Cassius Harris talks about how anyone, not just healthcare professionals, can be a hospice advocate.

When I started working here, I was under the impression that hospice advocacy only applied to those directly in the field – nurses, social workers, doctors, etc. Over time, I started questioning myself regarding my own feelings about hospice and end of life issues- Does hospice apply to me since my college degree is not in the medical field? Should it concern me since no one close to me is dying? Through my experiences, I have slowly come to the realization that anyone- regardless of profession – can be a hospice advocate if they have compassion for those at the end of life. Although having the educational credentials and background does help, advocacy does not require much except your willingness to have compassion for those that are at the end of life.Whether speaking to family members or friends, I find myself educating others on the basics of hospice because many people do not understand it’s benefits. Many people think it is a depressing subject that is not worth discussing. I have even met some people that mock it and joke about it. I explain to them that death is a serious issue and watching your love ones suffer in their last days can be unbearable.

When people ask me about my job I usually tell them that it is tad bit depressing but quite rewarding. Whether helping a consumer find a hospice in their local area or mailing out educational materials, I explain how wonderful it feels to promote an industry that can alleviate pain and suffering for caregivers and their loved ones.

With all of the information out there from websites to news articles, all one has to do is educate themselves and question their core values – how much do I care about people? What can I do to improve the quality of living at the end of life? Hopefully more and more people will become hospice advocates. All one has to do is look inside themselves and question their core values.


Learn more about the 2017 Hospice Action Network Advocacy Intensive, July 17-18.


CEO Edo Banach Hits the Road

Earlier this week, NHPCO’s newly-minted CEO, Edo Banach, visited with key hospice champions on Capitol Hill, including Senator Shelly Moore Capito (R-WV), Congresswoman Lynn Jenkins (R-KS), and Congressman Phil Roe (R-TN).  During the meetings, Edo discussed hospice policy priorities, NHPCO’s goals for the future of hospice and palliative care, and strategies for building Congressional support for hospice and palliative care.  This is part of NHPCO and HAN’s ongoing efforts to maintain and grow its presence on Capitol Hill and with the Administration.

Do you want to meet with Members of Congress on Capitol Hill? Make sure you register for the FREE Advocacy Intensive! Learn more here. 

To learn more about these issues – and to share *your* thoughts on the future of hospice and palliative care – mark your calendar and participate in NHPCO’s upcoming Summer Listening Tour. CEO Edo Banach will be travelling the country to listen to YOU, and hear from you about your vision for the future of hospice and palliative care. The current cities and dates are:

Las Vegas, NV – June 7
Chicago, IL – June 13
Austin, TX – June 14
Kansas City, MO – June 19
New York City, NY – July 12
Alexandria, VA – July 13
Atlanta, GA – July 24
Denver, CO – TBD
Boston, MA – TBD

Check out the Summer Listening Tour page for more information!

NHPCO CEO Edo Banach meets with West Virginia Senator and Hospice Champion Shelley Moore Capito on Capitol Hill.

Advocacy Needed!

You may have heard that there is A LOT going on in Washington, DC right now, so we need our Advocates to do two important things:

Please complete our Action Alerts on the following hospice and palliative care legislation:

  1. The Rural Access to Hospice Act
  2. The Palliative Care and Hospice Education and Training Act
  3. The Medicare Patient Access to Hospice Act
  4. And please share these links with your networks to help spread the word!

Please reach out and invite your Members of Congress to visit your program.  

  1. Congress has TWO upcoming district work periods (May 27-June 2, and July 3-7). This is the perfect time to invite your Members of Congress to visit your program, meet with your staff, and discuss the above-mentioned legislation.
  2. If you are a We Honor Veterans partner, please invite your Members of Congress to attend your upcoming Memorial Day and July 4th Honor Ceremonies.
  3. Check out our resources to help you host a Member of Congress:
    1. Find Your Members of Congress
    2. Email us if you need the scheduler’s email address!
    3. Template Invitation Letter
    4. Involving a Member of Congress in a We Honor Veterans Ceremony Video

You can find more resources in the Advocacy Toolkit on our website.

It is especially important that Congress hear from you, their constituents! We need you to show them what hospice and palliative care really looks like in their district, and be strong, effective advocates for the patients and families you serve. Please reach out to us if you need any help with finding the right Member of Congress, contacting their office, and/or organizing an event. And, if you do meet with Members of Congress, make sure to tell us about it!

Keep up the great work, and please let us know how we can help you!

Rita Isnetto (GA Executive Director), and Anna Evans (Music Therapist) at Seasons Hospice and Palliative Care in Atlanta, GA, hosted Senator Johnny Isakson for a discussion about the We Honor Veterans Program and how it helps care for the unique needs of Veterans at the end-of-life. You can do something similar!

The Senate Side of Repeal and Replace

Yesterday, the House passed the revised American Healthcare Act (AHCA), taking a key step towards the repeal and replacement of Obamacare/Affordable Care Act. The bill now goes to the Senate. So, what does that mean?

As widely predicted, the Senate is expected to re-write the House repeal and replace bill to accommodate procedural hurdles in the Senate as well as to address political and policy concerns.  The House bill, as amended, has not yet been scored by the Congressional Budget Office (CBO). The score is not expected for possibly two weeks. The Senate reconciliation rules require a CBO score in order to evaluate whether H.R. 1628, The American Health Care Act of 2017, is a privileged vehicle and which provisions violate the Senate Byrd Rule. This process is done in consultation with the Senate Parliamentarian and allows both sides of the aisle the opportunity to make their case.  This procedural and budgetary review is expected to take weeks.

In addition, the Senate will offer a substitute to the House bill and that substitute will also need to be scored prior to any floor consideration both for political and procedural requirements.  As a result, it is possible that the Senate doesn’t even start a debate until mid/late June at the earliest.

The Senate Leadership is expected to convene a working group of a cross section of Senators including Chairmen Hatch (Senate Finance Committee), Alexander (Senate HELP Committee) and Enzi (Senate Budget Committee) to address priorities and Member needs.  Issues that are likely to be addressed are: the adequacy of the tax credit, Medicaid construct, and how to address the insurance mandates, among others.  In the aftermath of the House celebration yesterday, Chairman Hatch emphasized that the Senate package will reflect their Members’ priorities coupled with the constraints of the reconciliation process, stating “We must manage expectation and remain focused on the art of the doable as we move forward.”

Our understanding is that the task force includes the following Members, representing Leadership, key constituencies and key issues:

> Hatch (R-UT)

> Alexander (R-TN)

> Enzi (R-WY)

> Thune (R-SD)

> Cruz (R-TX)

> Lee (R-UT)

> Cotton (R-AR)

> Gardner (R-CO)

> Barrasso (R-WY)

> Cornyn (R-TX)

> Portman (R-OH)

> Ron Johnson (R-WI)

Now, keep in mind that while hospice and palliative care are not expected to be impacted by the repeal and replace process, it is still important for advocates to pay attention to the process. Have any questions? Reach out to us at!