Congresswoman Van Duyne: Hospice Licensing Should Remain with the States

Hospice licensing should remain under the authority of state governments rather than federal agencies, though lawmakers “haven’t ruled anything out” when it comes to program integrity, according to Rep. Beth Van Duyne (R-Texas).

The congresswoman and fellow legislator Rep. Earl Blumenauer (D-Ore.) last month requested a briefing from the U.S. Centers for Medicare & Medicaid Services (CMS) on reported instances of hospice fraud in several states.

“I haven’t ruled anything out at this point. We are trying to get as much data as we possibly can, trying to hear as many opinions as we possibly can,” Van Duyne told Hospice News. “But I want to make sure primarily that the caregivers’ hands are not tied. We’ve been working with a number of stakeholders and committee members to ensure that everything at this point remains on the table to be thoughtfully discussed.”

Van Duyne sits on the oversight subcommittee of the Ways & Means Committee in the U.S. House of Representatives.

Central to the program integrity issue is a ballooning number of newly licensed providers that have engaged in suspicious practices, according to government and industry stakeholders. In some cases, numerous licensed hospices have been operating from the same addresses, often with the same CEOs, medical directors and staff.

These problems first drew attention in California, prompting state legislators to enact a moratorium on new licenses pending an audit of approval processes. Subsequently, similar instances were identified in Nevada and Arizona, as well as Van Duyne’s home state of Texas.

Last November, four industry groups called on CMS to strengthen federal oversight, including “targeted’ moratoria on Medicare certifications. Signatories on the joint letter included LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI).

Though it remains to be seen what actions Congress or CMS may ultimately take, Van Duyne said she believes that states should remain in control of licensing decisions.

“Each state is unique, and they have needs and they have to have the ability to determine where [hospices] are located in the states,” the congresswoman said. “I don’t think that there should be a federal bureaucrat in D.C. that knows nothing about the local needs in the communities.”

That doesn’t necessarily mean that federal policymakers have no role to play. CMS should “at least” have a system to detect when multiple hospices are registered at the same address, according to Van Duyne.

But, the congresswoman maintains, hospice providers must have a voice in any future decisions.

“We’re in the investigative phase right now, but we’re not taking anything off the table,” she told Hospice News. “I think it’s important to point out that the blame does not lie with the caregivers, and the government shouldn’t make it harder for them to do their job. I’m working to find ways to empower hospice care providers. They are the ones who best understand the needs of their patients, and we need to make sure that we are leaving ample opportunity to get their opinions on this before we move forward with any potential legislation.”