Advocacy Update: Questions and Answers

You might have heard the news that CMS posted the hospice final rule on Friday 7/31. We know you all have been chomping at the bit for more information about your advocacy, the rule, and what is going on. We are happy to present this question and answer exposition on the topic:

Was our advocacy successful? I thought one of the biggest things we asked for was a test run of the new payment method.

Your advocacy was absolutely successful! CMS delayed the implementation of the new payment methodology by three months. This is partially in reaction to the input of Members of Congress, who were spurred to action by your phone calls and visits here in DC.

Despite what you might have seen on The West Wing and House of Cards, policy successes don’t frequently come wrapped in a bow looking exactly like you thought they would. Due to time constraints, government agency practices, and competing priorities, the final product of your advocacy can take a very different shape. That’s what happened here: we didn’t get exactly what we wanted (a test run), but we’re happy the final rule gives more time for everyone to prepare for payment reform.

CapitolMany of our major concerns with the new payment methodology have been focused on its implementation. Almost everything we heard from the hospice community suggested that hospices were in favor of what the new payment rule would do, including how it might positively influence some questionable behavior, but we heard many concerns over how it would be rolled out. If CMS had kept to their original schedule, all of the stakeholders would have had a mere 60 days to adapt to the new payment model. Even with the extended implementation date, five months is a very short time for hospices, Medicare Administrative Contractors (MACs), software vendors, and State Medicaid Agencies to get all of their ducks in a row and change a payment system that’s been unchanged for over 30 years! While we still have concerns, the January 1 start date gives all stakeholders some breathing room to make sure that the transition goes smoothly.

OK, so the extra time is good, I get that. But I’m also confused. We asked our Members of Congress in the House of Representatives for their co-sponsorship of the Hospice Care Access Improvement Act. Didn’t that also ask for a test run? What happens with that now?

Great question, hypothetical question-asker! In the House, our ‘ask’ was to support the Hospice Care Access Improvement Act (HR 3037). This bill will mandate, by law, a test run of the new payment method. It also includes some NHPCO-supported program integrity proposals for the hospice community. Now that CMS has pushed back the implementation date for the new payment method, what becomes of HR 3037? Well, here are some things to consider:

  • CMS takes note of legislation in the same way it does of sign-on letters (i.e. Congress is ‘watching’), and we believe that introducing the legislation helped with the additional 3-month delay for the new payment methodology.
  • HR 3037 can be viewed in some ways as ”insurance.” While we’re thankful for more time to implement the new payment system, we aren’t out of the woods yet. If mid-December comes around and the hospice community is hearing that the new payment method isn’t ready to be rolled out, having a bill mandating a test run already introduced and widely supported on a bipartisan basis in Congress will be very helpful to have. And the more cosponsors it has at that point, the more useful it will be!
  • Your discussions with your Member of Congress in the House aren’t over! We here at HAN always stress that advocacy is a year-round endeavor! Take the opportunity to update them on CMS’ final rule, and offer to be in close contact with them about the rollout of the new payment method. Convince them to be part of the ‘insurance plan’ for hospice! Advocacy works best when you have a relationship before there is an urgent need, and this is a prime example of that.

OK- got it. On the House side, keep pushing for co-sponsorship of HR 3037, and wait for news from NHPCO and HAN. But wait–what about the Care Planning Act in the Senate?

Another good question there! In the Senate, we still need you to ask your Senators to sign on to the Care Planning Act. This bill is a high priority for our community, and it has the potential to be transformative for the hospice and palliative care community. If your Senators want to know how to help hospice, currently this is the #1 way. We’re also still working with stakeholders to get this introduced in the House of Representatives as well! Stay tuned!

So what’s next?
The Final Rule has only been out for a few weeks, and we want the hospice community’s response to be measured and well-crafted. You’ll certainly be hearing from us in the weeks and months ahead as we have more information. If you’re getting specific questions from your Senators or Congressmen that you’re unsure how to answer, feel free to reach out to us. HAN is happy to help you craft responses or provide advice on how to proceed. If you have any questions, you know where to find us, or let us know in the comments!

HAN: Behind the Scenes

I’d like to take a moment and explain to everyone some of the ‘behind the scenes’ work that we do here at HAN. You all see the Advocacy Intensive, the videos and policy updates, and the emails keeping you informed. What you may not know, is that one of the major wheels that keeps our office turning is our Grassroots Database. I have the distinct pleasure of maintaining that database, and am currently elbows-deep in trying to update email addresses, mailing addresses, career changes, and other information that we need to run a successful grassroots advocacy organization.

This is what happens when you never clean your database....not really, but it is our irrational fear.
This is what happens when you never clean your database….not really, but it is our irrational fear.

Most of the data you see on our website is pulled from this database. This is how we email Congress, how we email you, how we figure out who is an active-advocate, and who is ignoring our emails. It is really the brain of the operation (sorry Tony). But with extensive use, this brain can get…cluttered. Part of it is because it has not been cleaned out in a very long time. Part of it is simple facts of life: people change jobs and email addresses and last names. It is a dirty, time-consuming, and rather boring job. But it is essential to the efficient functioning of our team.

Do you have a part of your job that is essential, but perhaps not the most exciting? Every job has those duties. Here at HAN, we take the month of August to try and focus on those jobs while Congress is back in the district. That way, when they come back to DC…we are waiting for them.

Concerned about the Hospice Final Rule? Learn from the experts!

I know everyone here is used to listening to Tony, Karen and (eek!) myself, but maybe you’d like to hear from some other voices for a change?

More likely, you might have some serious questions/concerns about the new changes CMS has undertaken in the FY2016 Final Rule. Well, fear not! Judi Lund Person, VP of Regulatory Compliance, and Carol Spence, VP of Quality & Research, will be presenting a Webinar on August 25, 2015 that will examine the FY 2016 Hospice Wage Index Final Rule and help you understand the many important provisions it contains.

The 90 minute program will air from 2:00pm-3:30pm EST on August 25, 2015. To register for the Webinar, please visit this registration page.

Both of these ladies are phenomenally well-versed in all things CMS, and I am sure this will be an incredibly informative presentation. A great one for an IDT/office meeting! Hope you can join us!


So what has HAN done for you lately?

One of the most frustrating things about politics and the legislative process is the stop/start/go/wait/yes/no nature of it. We were blowing up your inbox, your facebook, your twitter, having call-in campaigns and generally shouting from the rooftops in July, and now it’s all radio silence. What gives?

Well, there has been a lot going on behind the scenes here in DC. First and foremost, the Centers for Medicare and Medicaid Services (CMS) posted the final rule last Friday and it included a 3 month delay in the implementation of the new payment model for routine home care, which will now start on January 1, 2016. This is undeniably in part because of your advocacy!

Beginning on January 1, 2016, routine home care payments will change to the new two-tiered rate. The new service intensity add-on (SIA) payment will also begin on January 1. Members can view the more detailed Regulatory Alert on the NHPCO website.

The halls of Congress are empty during recess, but that does not mean HAN isn't working!
The halls of Congress are empty during recess, but that does’t mean HAN isn’t working!

We’re sure you have questions, and HAN is working closely with our Congressional champions to figure out some crucial next steps. Congress is back at home for the August in-district work period now, so it’s taking us a little longer to dot all the i’s and cross all the t’s. We hope to have a full explainer email out to you soon that gives an in-depth look at what’s next for Hospice Advocacy in the 2nd half of 2015. In the meantime, Jonathan Keyserling, our esteemed Executive Director, has taken the time to talk through where we are now and what to expect in the near future.

If you have specific questions, feel free to reach out to us directly. If you need talking points or advice for follow up on a Congressional site visit, we’re happy to have a call or email conversation with you. And make sure you are taking advance of the August Recess, and visiting/contacting your Members of Congress while they are in the district. They might be harder for us to track down, but they are right in your backyard! Help us out and make contact with them while they are in the district office.

Again, you’ll hear from us soon with a more detailed update. Until then, thanks for all you do, and have a great weekend!

What is #HPM?

Every Wednesday night at 9pm EST, there is an online tweet-chat in the hospice and palliative medicine (hpm) community. There is a rotating moderator and topic, and people tweet in using #hpm. As most discussions go, there is typically a core of active participants, and I am sure several more people who just ‘lurk’ in the background. Last night’s topic was hospice and palliative overlap and the MCCM. Some of the concerns presented would be address by the Care Planning Act, so hopefully we continue to see momentum on that bill.


Karen and I were hanging out in #hpm chat last night, and I typically pop in most Wednesday evenings. It would be great to see more of you there! (Shout out to @TheGilb84, who I see there frequently) You may find that you enjoy the casual, friendly atmosphere with other people familiar with our industry.

Similarly, make sure to tune in to the debate tonight on twitter and facebook if you want to see how other people use social media for advocacy and policy. I am sure you will see MANY people doing it badly, but hopefully you can also pick out some people doing it well. Feel free to link to the good, the bad, and the ugly in the comments below!