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.
Many 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!