Bill to Re-Allocate Federal Hospice Dollars Moving Forward in Congress

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A new legislative package winding its way through Congress could re-allocate hospice funds to other programs.

Lawmakers incorporated language from proposed amendments to the Social Security Act into a six-bill “minibus” (as opposed to an “omnibus). If enacted, it would make adjustments to the hospice payment cap for 2033 that would free up $927 million. Congress intends to reinvest those dollars into pharmacy benefit management, behavioral health and other projects.

The nation’s four largest hospice industry groups have voiced opposition to these provisions. The National Hospice and Palliative Care Organization, LeadingAge, the National Association for Home Care & Hospice and the National Partnership for Healthcare and Hospice Innovation have been in communication with lawmakers in hopes of keeping the funds within the hospice program.

In a joint letter to congressional leaders in both chambers, these organizations maintained that these savings should be reinvested in hospice programs.

“We object to the prospect of any savings from this extension being used to pay for activities that would not be focused on improving care for hospice patients and their families,” the groups said in the letter. “At a time when the population is aging rapidly, the demand for high-quality end-of-life care is increasing and only half of people with Medicare who die each year use any hospice at all, it is concerning that Congress would use the [Medicare Hospice Benefit] as a ‘piggybank’ to fund programs totally unrelated to the provision of hospice services.”

This potential action from Congress is not entirely new. The current bill would extend this practice to 2033. However, the amount of re-allocated dollars would grow from about $500 million currently to nearly $1 billion.

These adjustments have their roots in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which changed the way the hospice aggregate payment cap is calculated. For Fiscal Year 2024, the cap is set at $33,494.01 for next year.

Since then, Congress has used funds gained from cap adjustments to shore up other programs or support additional policies. Now hospice advocacy groups are contending that the money should go to efforts to improve hospice quality. This would include implementing changes to the survey process and surveyor training that the U.S. Centers for Medicare & Medicaid Services (CMS) has been working to implement since 2022, according to their letter.

“Unfortunately, the Senate legislation, while advancing other health policy priorities, does not include any policies that would support or improve the hospice program,” the letter indicated. “It is disappointing to see an offset that was initially created to improve hospice quality be used for dozens of non-hospice issues, especially given that the savings this change produces have grown almost 20-fold since it was first utilized.”