Hospice providers will be looking to Congress in 2024 to address issues related to program integrity, quality improvement and industry-wide workforce pressures. As legislative efforts develop, hospices may want to focus their attention on a few key legislators.
Though hospice is largely a community-based business, actions on the national level can have a huge impact. Congress has driven many of the changes that have occurred in the hospice space during the past several years. This includes the revamping of the hospice survey process and the establishment of a Special Focus Program (SFP) slated to begin in 2024, to name a few.
Lawmakers have an essential role in ensuring the viability of the Medicare Hospice Benefit, according to Davis Baird, director for government affairs for hospice at the National Association for Home Care & Hospice (NAHC).
“What we would love for our lawmakers to do is really champion the program as it exists and make sure it’s protected from threats to its payment system,” Baird told Hospice News. “But also we understand that there are areas where there needs to be more exploration for how the benefit can best support patients and families in 2024 and beyond. So, having those conversations about what those improvements would be is going to be an important exercise in 2024.”
One key priority for the hospice community is to secure updates to the algorithm that the U.S. Centers for Medicare & Medicaid Services (CMS) intends to use for identifying hospices for its forthcoming SFP.
Many hospice stakeholders have expressed support for the SFP program as a concept, but a vocal contingent has raised concerns that the agency’s methodology for selecting participants is deeply flawed.
The nation’s four largest hospice industry groups, as well as some members of Congress themselves, have called on CMS to postpone the program and revise that algorithm. As of now, however, the agency intends to move forward with its current algorithm, as indicated in its 2024 home health final rule.
Changes to the SFP will be top priority for industry groups that will work with policymakers in the new year, according to Logan Hoover, vice president of policy and government relations at the National Hospice and Palliative Care Organization (NHPCO).
“We are severely concerned with the direction that CMS has taken on this program. We don’t have confidence in the algorithm that they proposed. We don’t believe that it’s going to accurately identify the bottom 10% of hospices,” Hoover told Hospice News. “We feel that there are going to be hospices that are identified as a poor performing hospice that are not poor performing. And that’s going to have real ramifications for not just those providers, but the communities that they serve.”
In addition to these issues, the hospice community and some legislators will likely continue to seek action on bills that could bolster the industry’s dwindling workforce.
For nearly a decade, stakeholders have sought passage of the Palliative Care and Hospice Education Training Act (PCHETA).
If enacted, PCHETA would support hospice and palliative care training programs for physicians, nurses, pharmacists, social workers and chaplains. The bill would also expand continuing education and career development programs and incentives in these fields.
Amid the federal government’s many competing priorities, several lawmakers have emerged as champions for hospice and palliative care policies. While this list is by no means exhaustive, it represents a number of the key legislators that have sought to enact new hospice and palliative care policies as well as protect the integrity of the Medicare benefit.
Also important to note is the role of congressional staff in crafting legislation and engaging with stakeholders. These professionals often play a crucial role in advancing public policy, including those who work specifically for the committees.
“You’ve got good staff on both sides [of the political parties] who we’ve had good conversations with,” Larry Atkins, chief policy officer for the National Partnership for Healthcare and Hospice Innovation (NPHI, told Hospice News. “The staff will continue to play a major role on these issues.”
Rep. Beth Van Duyne
Rep. Beth Van Duyne, (R-Texas) has emerged as one of Washington’s most vocal advocates for hospice providers in Congress.
Elected to the U.S. House of Representatives in the 2020 election, Van Duyne is a member of the influential House Ways and Means Committee, which holds dominion over Medicare, Social Security and tax policies among other programs.
Van Duyne was among a group of lawmakers that wrote to CMS Administrator Chiquita Brooks LaSure requesting that the agency reconsider its approach to the hospice SFP. She has also been active in congressional efforts to address program integrity issues that have emerged in four states, including her home state of Texas, California, Nevada and Arizona.
Any regulatory action should take input from the hospice community into consideration, Van Duyne told Hospice News in June.
“There are opportunities to start making additional regulations. But before we start our policy in place, my first thought right now is talking to more of those people who are providing this critical care, because what I’ve seen so far is that care providers are desperate for regulations,” she said. “But they don’t want to get lumped in with bad actors, and they don’t want us creating needless regulations that are going to hamper their ability to do that care.”
Rep. Earl Blumenaur
Rep. Earl Blumenaur, (D-Oregon), was first elected to Congress 27 years ago and later also gained a seat on the Ways and Means Committee. Since then, he has sponsored a number of bills designed to improve the quality of hospice care as well as combat fraud in the space.
He has co-led a number of bipartisan initiatives to improve program integrity within the Medicare Hospice Benefit, often in partnership with Van Duyne.
“The vast majority of people in the industry are committed to the principles and the practice and the delivery. There are, in fact, some outliers. We’ve watched people who’ve just abused the system and compromised the protections and services that have been given to some of our most vulnerable people,” Blumenauer told Hospice News in June. “There are people who are running hospice programs that are only theoretical. They’re not actually providing services to people, and they are bleeding money from the federal government.”
Blumenauer was also among four members of Congress that called on CMS to delay the hospice Special Focus Program program to revise its algorithm for selecting providers. In addition to him and Van Duyne, Jimmy Panetta (D-CA) and Brad Wenstrup (R-OH) were also signatories on the letter to CMS.
He has also called for more lasting reform to the Medicare Hospice Benefit to ensure it continues to meet patients’ changing needs, including those with dementia.
Throughout his career, Blumenauer sponsored legislation that would allow end-of-life patients access to psychedelic therapies, reduce medication costs, improve quality measurement and expand access to advance care planning. He also wrote some sections of the Affordable Care Act.
In 2009, he introduced the Advance Care Planning and Compassionate Care Act, which was designed to educate clinicians and the public about hospice and palliative care, foster greater utilization of advance directives and allow for concurrent care for children.
Seven years later, Blumenauer sponsored the Personalize Your Care Act 2.0, which aimed to establish new models of care for serving seriously ill patients, including provisions aimed to improve awareness and utilization of hospice and palliative care.
Last month, Blumenauer announced that he would not seek re-election at the end of this term. But for now, his work in Congress continues.
Rep. Jimmy Panetta
Rep. Jimmy Panetta (D-California) first took office in 2017 and currently also serves on the Ways and Means Committee, which is among the most important congressional bodies to watch for hospices, according to Hoover and Baird.
During his tenure in Congress, Panetta has spoken out against the SFP algorithm in conjunction with other lawmakers. But one of his most significant contributions was the writing of the Helping Our Senior Population in Comfort Environments (HOSPICE) Act with Rep. Tom Reed (R-New York), which revamped the hospice survey process and mandated the SFP, among other provisions designed to improve the quality of hospice care nationwide.
Components of the HOSPICE bill were included and enacted through the Consolidated Appropriations Act of 2021. The legislation was developed in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS).
“Jimmy Panetta from California has been a long-time champion [for hospice and palliative care],” Baird said. “He wrote the HOSPICE Act that has resulted in a lot of the program integrity and oversight changes that we’re working on the last few years and continue to work on.”
Sen. Jacky Rosen
Sen. Jacky Rosen (D-California) has been among the most significant voices for hospice in the U.S. Senate.
In 2019, she spearheaded the establishment of the Senate’s Comprehensive Care Caucus in 2019 to focus on legislation and policy to raise awareness of and improve access to palliative care. Since then, she’s been involved in a range of legislative activity affecting the space.
Rosen this year introduced the bipartisan Provider Training in Palliative Care Act. Similar to PCHETA, the bill aimed to increase the number of clinicians trained in palliative care as long-standing labor shortages continue to hinder access.
If enacted, the legislation would allow medical students in the National Health Service Corps’ (NHSC) to defer clinical service requirements for up to one year to pursue additional training in palliative care. They also would provide primary care during their time of service with NHSC.
A second bill she introduced this year was designed to improve access to blood transfusion care for hospice patients.
The Improving Access to Transfusion Care for Hospice Patients Act would create a reimbursement pathway for blood transfusion services within the Medicare Hospice Benefit. This would allow hospice providers to bill Medicare separately for transfusion services.
Rosen was also among four U.S. senators that introduced a bipartisan bill that would direct the Center for Medicare & Medicaid Innovation (CMMI) to develop a palliative care-specific payment model demonstration.
The bill’s co-sponsors included John Barrasso (R-Wyoming), Tammy Baldwin (D-Wisconsin) and Deb Fischer (R-Nebraska.), all of whom are cofounders of the Comprehensive Care Caucus.
Among the bill’s priorities is ensuring that patients can access palliative services earlier in their disease trajectory, according to Rosen.
“Palliative care has been shown to improve health outcomes and quality of life, but unfortunately, for seniors, it is only currently available to patients in hospice,” Rosen told Palliative Care News in a June email. “That’s why I’m introducing bipartisan legislation to expand Medicare coverage of palliative care, making it available to seniors earlier in the diagnosis and treatment process. As a co-founder of the Senate’s Comprehensive Care Caucus, I’ll always work to improve the quality of life for patients and their families.”
Sen. John Barasso
In today’s fractious political environment, hospice and palliative care is among the areas where the nation’s two main political parties have found common ground.
Sen. John Barasso (R-Wyoming) has been a frequent collaborator with Rosen on legislation and other congressional action. A co-founder of the Comprehensive Care Caucus, he has been involved in nearly every bill that entity has produced.
“We’ve had continued engagement from the Comprehensive Care Caucus,” Hoover said. “Senators Rosen, Barasso, Baldwin and Fischer have always been really the long-term champions of hospice. We’re excited that they’re going to continue.”
Barasso has been a co-sponsor on Improving Access to Transfusion Care for Hospice Patients Act, Provider Training in Palliative Care Act and the proposal to establish a CMMI demo around palliative care, among other bills.
Sens. Tammy Baldwin, Shelly Moore Capito
Sens. Tammy Baldwin (D-Wisconsin) and Shelley Moore Capito (R-West Virginia.) earlier this year reintroduced PCHETA, designed to help rebuild the field’s shrinking workforce with federal support.
If enacted, the legislation would establish fellowships through new palliative care and hospice education centers to provide short-term, intensive training, as well as incentivized award programs across all the relevant disciplines.
It includes provisions for additional training for medical school faculty and other health care educators, as well as provider resources for workforce development and nurse retention projects.
Beyond the staffing issue itself, PCHETA would also create new avenues for raising public awareness of hospice and palliative care. This is the latest attempt to pass the bill, which has been reintroduced several times, most recently in May 2022, also by Baldwin and Capito.
“Sen. Baldwin leads PCHETA with Sen. Capito from West Virginia. They remain very engaged on the workforce side of the space,” Ethan McChesney, policy director at NPHI, told Hospice News. “Workforce is obviously the big one. This is the third or fourth Congress in which [PCHETA] has been reintroduced, and it has strong bipartisan support. But it looks like there’s not going to be a vehicle before the end of the year to get that across the finish line.”
Companies featured in this article:
National Association for Home Care & Hospice, National Hospice and Palliative Care Organization, National Partnership for Healthcare and Hospice Innovation
