NHPCO Submits Recommendations for Hospice Regulatory Relief to House Ways and Means Committee

In response to a request from the U.S. House of Representatives Ways and Means Committee, the National Hospice and Palliative Care Organization has submitted a series of recommendations that would provide regulatory relief to hospice providers.

The recommendations were developed by the NHPCO regulatory committee, and echo concerns raised in NHPCO’s comments to the Centers for Medicare and Medicaid Services regarding the FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements; Proposed Rule.  NHPCO’s letter of June 26, 2017 to CMS (PDF) is available online.

In summary, NHPCO highlighted areas where Congress and CMS could reduce regulatory burden around payment policy, staffing requirements, audits, and data collection and reporting.  NHPCO also called for Congress to enact legislation that would loosen requirements around Face-to-Face, and allow both Rural Health Clinicians and Physician Assistants to serve as the hospice attending physician.

NHPCO President and CEO Edo Banach wrote in the letter to Congress, “In recent years, hospices have been faced with substantially increased regulatory burdens, based on new regulations and subregulatory guidance, changes required by hospice payment reform, additional quality reporting obligations, and increased audit activity. While some of these changes are positive, hospices report that they are facing many regulatory burdens that take valuable staff time away from patients and are not increasing the quality of care provided.”

NHPCO leadership, staff, and members are eager to work with Congress on these issues, as well as other policy changes that will ensure that all Medicare beneficiaries can access the high-quality, compassionate end-of-life care offered by hospice providers across the nation.


To speak with a member of NHPCO’s health policy staff, contact:
Jon Radulovic
Vice President, Communications
Ph: 703-837-3139

August Hospice and Palliative Care News Update!

Labor Day Weekend is here already! As you prepare for the end of summer, get caught up on the latest in hospice and palliative care news:
Regulatory Update:
From the Desk of the CEO:
A Broader Lense:
Advocacy Shoutout:
Many of you are working on getting Members of Congress to visit your programs, and putting together coalitions of hospice and palliative care organizations in your state to show the Members that a wide swath of the community supports our policies. Thank you for your hard work!
Recently, Hope Hospice in Fort Myers, FL hosted Congressman Francis Rooney, Seasons Hospice and Palliative Care in Des Plaines, IL hosted Congressman Brad Schneider, and Treasure Valley Hospice in Nampa, ID hosted Senator Crapo’s Staffer Rebecca Alcorn, who was able to meet with their patient Phyllis Redifer on her 102nd birthday!
Don’t forget to check out our Legislation Tracker and Advocacy Toolkit for resources to understand policy and get involved! Congress comes back from August Recess on September 5, so that would be a great day to Call or Email your Members and remind them to support our policies!
Is there a resource you need or other tips you have to improve our website? Let us know! We want to make sure we provide as much information as possible to make advocacy easy for you!
Thank you for the amazing work you do, and a special digital hug to everyone in Texas and Louisiana coping with the aftermath of Hurricane Harvey. Please reach out if we can be of any assistance.

Help Hospices in the Wake of Harvey

The scope of the natural disaster in Texas is overwhelming. NHPCO has heard from a number of members throughout the country asking about ways to best support our hospice and palliative care colleagues in regions of Texas who are coping with the ongoing devastation of Hurricane Harvey and the continuing rains and flooding.

First, NHPCO extends thoughts and prayers to all those affected by this natural disaster. We know that hospice and palliative care professionals are continuing to care for patients and family members despite flooding, blocked roads, power outages, property damage and personal loss. As the full impact of the situation unfolds, we stress the importance of safety as our colleagues face the brunt of this disaster.

During times of such disasters, it is essential that concerned individuals recognize the importance of following the direction of first responders and the agencies that are on the ground addressing the most critical needs. In these initial hours – and as the impact of flooding continues – we must heed the advice of emergency management systems that are responding as designed.

As with previous events of this nature, NHPCO traditionally coordinates with state associations to respond in the most effective manner; we have found that state associations best know the needs and priorities of providers in affected regions. Our leadership is working to contact our colleagues at the Texas & New Mexico Hospice Organization based in Austin. We will learn more about the best ways to support our colleagues and providers in the region in the days and weeks ahead.

One way we have supported providers in areas affected by tragedies such as this is through the National Hospice Foundation (NHF) Disaster Relief Fund. This fund was specifically established to aid the hospice community when disaster overwhelms regularly-available resources. We have found that financial donations are one of the most helpful ways to address needs in the imminent wake of destruction. NHPCO and NHF will be collecting donations through the fund and giving to the Texas & New Mexico Hospice Organization to use in the ways that will be most beneficial. We welcome your support of the NHF Disaster Relief Fund; to donate, please visit the NHF donation page online.

Tragedy and loss are part of our world. Yet amid the wreckage and destruction, hope can be found. By surviving disasters, such as the hurricane and flooding that we are watching unfold in Texas, people recognize that they are part of a greater community, a community built upon our shared humanity. Ultimately, tragedy can show people they have more resiliency and strength then they realized. Neighbors help neighbors. Communities come together to rebuild. It becomes clear that survival is possible. While we cannot stop the forces of Mother Nature, we learn that the care and support of family and friends is essential.

What’s Next?

I’m not a fan of goodbyes. I also don’t like being the center of attention. So I’m going to keep this short.

Today is/was my last day at NHPCO and HAN. I’m joining my husband on an adventure to the northern plains, where he is a newly-minted Instructor of Creative Writing.

I’ve been struggling with the words for post for some time now. But what all of my thoughts and feelings boil down to is this: it has been my privilege to work with such passionate Hospice Advocates in the nearly 6 years I’ve been at NHPCO. Writing policy briefs and attending MedPAC meetings can sometimes be dull. But YOU, our front-line advocates, remind me why I do this job. Hearing your stories, and the stories of the patients and families you care for, renewed my sense of purpose in this organization. Indirectly, I have helped you and your organizations provide better care for your patients and families. And a job in DC doesn’t get much more rewarding than that.

Thank you for counting me among your ranks as a Hospice Advocate over the years. And please let me carry that title with me as I move to the next step in my journey. Who knows…I may show up at the next Advocacy Intensive as a hospice volunteer!

All my best,

Edo Banach Responds to Kaiser Health News/WaPost Article

Dear Editor:

There is no question that the U.S. is coping with an opioid epidemic of overwhelming proportions. Unfortunately, the article from Kaiser Health News published in The Washington Post, “Dying at home in pain doesn’t keep relatives from stealing the pills,” unfairly points to the hospice community’s role in exacerbating this national crisis.  That could not be further from the truth.  Hospices take seriously their obligation to maintain the health and safety of patients and their loved ones.  Hospices have an obligation to the community and the patient to be sure that the medications are used appropriately, which includes careful monitoring of the patient’s pain and the family and home situation. However, hospices – and those who work for them – generally do not have the authority to confiscate or destroy unused opoids or other pills.

As the author states, “The U.S. Drug Enforcement Administration encourages hospice staff to help families destroy leftover medications, but the agency forbids those staff members from destroying the meds themselves unless that is allowed by state law.”  I think it’s important to be perfectly clear, in most states, hospice professionals cannot touch the medications of a patient who has died – they belong to the family.  At the same time, Federal regulations require hospice professionals to go over the federal drug disposal guidelines with family caregivers, but hospice professionals areprohibited from taking a more active role in disposing or removing medications from the home.

Some states have taken action to put more control in the hands of the hospice professionals, but NHPCO supports a national policy and uniform set of practices.  To this end, NHPCO has already drafted legislation and has been working with Congress to expand the ability of hospice professionals to take a more active role in helping families dispose of these drugs.

Hospice professionals are trained in engaging with families about these medications – this includes addressing concerns of diversion or theft. Certainly, there are situations where a hospice professional failed, but such an instance should not be used to describe the entire provider community in this country. The 2013 study out of Virginia cited in the article, which reflects the practices of 23 hospices in Virginia, ultimately lead to training and resources made available throughout the state and country.

The author’s assertion that “hospices may go years without inspection” is not accurate. Legislation passed in 2014 (the IMPACT Act of 2014), strongly supported by the hospice community, requires hospices to be surveyed at least every three years. The hospice community has long worked with regulators to ensure high standards of practice, compliance and safety in the field.

Drug diversion by friends, family members and caregivers must be addressed. However, readers of this article who may have a loved one in hospice – or be under the care of hospice themselves – should not be frightened by medications used to relieve suffering. If a patient or family has any concerns, please reach out to the hospice team providing care.

Not only are hospices working to do the right thing for patients and families, but they are also working to ensure that the pain and suffering of dying Americans is properly addressed. And no professionals are better trained to do this than those working in hospice and palliative care.


Edo Banach
President and CEO