Policy Alert: Congress Considering Changes to Hospital Discharge to Hospice

Congress is currently in the process of negotiating a package of Medicare-related legislation that would cut payments to hospitals when a hospice transfer is made sooner than a Medicare-established average length of stay.  The rationale for this change is that the federal government should not pay two providers (both hospitals and hospice agencies) for the same days of care.  A similar restriction is currently in place for when a patient is discharged to home health, psychiatric hospitals, and other settings, so this change would put hospice in the same category as other post-acute care providers.  Further, the change would save the government a significant amount of money – between $600 million and $1 billion.

NHPCO has been closely engaged on this issue since early December.  We consulted with the Public Policy Committee to discuss the potential impact of this change, and many expressed concern that this could incentivize hospitals to delay hospice referral until after the patients has stayed long enough to receive the full payment, potentially resulting in shorter lengths of stay in hospice.  NHPCO has conveyed these concerns to key legislative staff to determine whether Congress would consider alternative approaches that would assure patient access to hospice.  These conversations are ongoing, and we hope that the final policy will address our concerns and remove any unnecessary barriers to hospice.  We are also working to include the Rural Access to Hospice Act as part of the larger legislation.

All NHPCO members are encouraged to contact their members of Congress to share their concern about the proposed hospital DRG change, and to encourage them to protect hospice and include the Rural Access to Hospice Act in the Medicare extenders package.  To contact Congress about this issue, visit the Our Rural Action Center.

If you have any questions or need additional information, contact info@nhpcohan.org.

Medicare Extenders Update

Written by Sharon Pearce, VP Public Policy:

Congressional Republicans seem to have gotten their holiday wishes, as the House and Senate passed major tax reform legislation this week.  It’s been decades since Congress last made major changes to the tax code, and this has been a long-time legislative goal for President Trump and the Republican Congress.

Because tax reform consumed so much Congressional energy in the last month, Congress left several important items unfinished as it left town for the holidays. Before they adjourned, Congress passed a one-month extension to give itself more time to complete several legislative priorities, including the FY 2018 budget, re-authorization of the Children’s Health Insurance Plan, and a bill popularly known as “Medicare Extenders”.

NHPCO has been working to convince Congress to pass the Rural Access to Hospice Act as part of the Medicare Extenders package. This legislation would increase access to hospice care, especially in under-served communities by allowing clinicians at Rural Health Centers and Federally Qualified Health Centers to serve as the hospice attending physician.  All HAN Advocates are encouraged to reach out to their Members of Congress to urge them to contact committee staff to encourage them to include the Rural Access to Hospice Act in the Extenders package. Click Here to Take Action.

So that’s it for 2017.  We will need you rested and refreshed to start advocating right away in 2018!  With your help, 2018 could be a great year for hospice and palliative care policy.  Thank you for all you do to support the Hospice Action Network!

Hospice Compare Refresh is now Available

CMS announced that the Hospice Compare Quarterly Refresh is available today, December 12, 2017. This quarterly Hospice Compare refresh presents results for patient stays discharged for Q1 2016 – Q4 2016 for HIS data.

Visit Hospice Compare to view the results.

The next refresh of Hospice Compare is scheduled for February 20, 2018 and will include HIS and CAHPS quality measure data.

REMINDER: Remember to review your provider preview reports and CAHPS® Survey provider preview reports in your CASPER folder. These reports include Hospice Item Set (HIS) quality measure results from Quarter 2- 2016 to Quarter 1-2017 and your facility-level CAHPS® survey results from Quarter 2, 2015 to Quarter 1, 2017. Providers have 30-days to review their HIS and CAHPS® results (December 1, 2017 through December 30, 2017).

If you believe there are errors in the results from the HIS measure and/or CAHPS® Survey data, you may request CMS review following the process outlined on the HQRP Public Reporting webpage and the Hospice Quality Public Reporting- CAHPS® Preview Reports and Requests for CMS Review of CAHPS® Data webpage.

For more information on how to access these reports, view the HIS Preview Report Access Instructions and the Hospice CAHPS® Provider Preview Reports Access Instructions.

Feel free to email your questions to NHPCO at quality@nhpco.org.

NHPCO Meets with CMS Administrator Seema Verma

Written by Judi Lund Person, Vice President, Regulatory and Compliance

On Wednesday, December 13, NHPCO’s President and CEO Edo Banach and I attended a productive meeting with CMS Administrator Seema Verma. Hospice Action Network Board Members Mark Murray, a hospice provider in South Bend, Indiana in Seema Verma’s home state, and Angie Sells, from AseraCare, a multi-state hospice provider attended the meeting as well and eloquently represented the hospice provider voice. The planned agenda for our meeting with Administrator Verma included a quick review on facts about hospice, our response to the Centers for Medicare and Medicaid Innovation (CMMI) request for information and progress on the Medicare Care Choices Model (MCCM), the impact on hospice when Medicaid managed care is in place, and concerns related to  Hospice Compare.

Pictured at the NHPCO office pre-meeting are NHPCO Vice President of Regulatory and Compliance Judi Lund Person, AseraCare President Angie Sells, NHPCO President & CEO Edo Banach, and Center for Hospice Care President & CEO Mark Murray.

On Wednesday afternoon, we made our way to the Hubert Humphrey building in downtown DC to meet with Administrator Verma.  She was joined by five members of the CMS staff, representing both the Center for Medicare and the Center for Medicare and Medicaid Innovation.  We began with a few quick data facts about hospice but quickly moved to a robust discussion about innovation, where we shared why the hospice and palliative care patient-centered approach is exactly in line with the Administrator’s goals for patient-centered care.  Administrator Verma was particularly interested in how hospices can be involved with patients earlier in their disease process, and we discussed the need for care navigation and coordination and how hospices are already involved in that process.

The meeting with Administrator Verma (center) was productive and informative.

We also had a discussion about the MCCM and talked about some of the limitations of the model, as well as what the learning has been.  We commented that the supportive services offered in the MCCM model are exactly what many patients need before they elect hospice.  Our hope is to build on that learning as we consider additional models.

It was clear from our discussions that innovation is a high priority issue for the Administrator.  Our visit highlighted the skills and experiences of hospice providers to participate in models for seriously ill patients and develop new models to ensure that patients and their families have the care and supportive services they need.  We agreed to continue our discussions with Administrator Verma and CMS staff at the meeting. It was a productive and useful meeting, and we look forward to continuing to build upon the strong working relationship between NHPCO and CMS.

What’s Going on in Congress?

VP of Public Policy Sharon Pearce breaks down the busy end-of-the-year schedule in Congress:

As the December holidays are upon us, Congress is scrambling to complete a long list of legislative  “to-dos” before heading out at the end of the month.  Of particular importance to the hospice community is the FY 2018 spending package, a bipartisan Medicare extenders package, a hotly contested tax reform bill and an extension of the CHIP program.

Just this week, Congress passed a two-week stop-gap spending measure that will keep the government open through December 22nd.  This gives Congress a few more weeks to finalize the FY 2018 budget, but lawmakers acknowledge that another extension will likely be necessary.

Bipartisan discussions are also underway for a package of Medicare “extenders” policies.  The Ways & Means Committee recently released its package of extenders (https://waysandmeans.house.gov/ways-means-committee-leaders-announce-bipartisan-medicare-extenders-package/), and the Senate is also working on its version.  For the most part, this legislative package is not controversial.  However, Congress will have to come up with “offsets” to pay for these policy extensions, and that could tee up potential cuts to provider payments.  NHPCO is working hard to ensure that hospice payments stay OFF the chopping block.

Congressional Republicans have also been working furiously to pass a major tax reform bill that could have several implications for the health care sector. In order to stay within the budget rules, the bill has a provision that would double sequestration from 2 to 4 percent if the bill substantially increases the deficit.  Proponents of the bill have argued that the bill would drive economic growth, so the trigger would not be tripped. To alleviate provider concerns, however, lawmakers have promised to take future legislative action to prevent any increases in sequestration.  The bill is currently in a joint House/Senate Conference committee.

Finally, Congress is considering extending sequestration – which is set to expire in 2025 — for an additional two years in order to extend the Children’s Health Insurance Program.  Health providers have expressed concern about continuation of the 2 percent cuts, but Congress seems poised to move forward with this change.

NHPCO will continue to track activity around this legislation and work to make the concerns of hospice organizations heard on Capitol Hill.