Hospice Act Passes House

hospiceAmericans need to know that all Medicare-certified providers are committed to the highest standards of quality and compliance.  This new law strengthens oversight and transparency throughout the entire hospice community.–J. Donald Schumacher, National Hospice and Palliative Care Organization (NHPCO) president and CEO.

HR-5393 Hospice Opportunities for Supporting Patients with Integrity and Care Evaluations Act (HOSPICE Act)

HR-4994  Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act)

In his Sept. 17 Press Release, Tom wrote:

Tom Reed’s bipartisan Hospice Opportunities for Supporting Patients with Integrity and Care Evaluations Act (HOSPICE) passed in the House of Representatives Tuesday. Provisions under Reed’s bill would strengthen access to quality hospice care and give hospice providers the tools they need to do their jobs more effectively. Reed’s HOSPICE Act was included in the House-passed IMPACT Act (Improving Medicare Post-Acute Care Transformation Act).

Kudos to Tom, but here is the rest of the story:

  • HR-5393 Hospice Opportunities for Supporting Patients with Integrity and Care Evaluations Act (HOSPICE Act), Reed’s bill, never passed the House.
  • Bipartisan? HR-5393 did have one cosponsor, California Democrat Mike Thompson.
  • Provisions of HR-5393, Reed’s bill, were included in HR-4994  Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) sponsored by Rep. Dave Camp. Tom is not listed as a co-sponsor. This bill passed the House on a voice vote.

According to Tom’s Sept. 17 press release, his bill had two provisions:

First, the bill brings additional transparency and accountability measures to certified hospice facilities with a three-year recertification cycle as opposed to the current six to eight-year timeframe. The increase in hospice survey frequency means hospice centers are more attentive to the changing care patients need. 

Second, the HOSPICE Act allows the Centers for Medicare and Medicaid Services (CMS) to conduct a review of hospice programs that reach a threshold of patients in hospice care for more than 180 days, ensuring that those in most need of hospice care are supported. 

Tom is often concerned about bureaucratic regulations and spending, what about that?

According to the CBO:

The legislation would increase direct spending by appropriating $222 million over the 2015-2024 period for activities related to survey and certification requirements for hospices and for the development and use of standardized assessment and quality data for post-acute services furnished to Medicare beneficiaries. The legislation would authorize the Secretary of Health and Human Services to spend $195 million in 2020 or subsequent years to increase payment rates for services furnished in the fee-for-service sector. The legislation also would reduce direct spending by reducing Medicare’s payment rates for services furnished by skilled nursing facilities that do not report assessment and quality data and by reducing the caps on payments for beneficiaries receiving hospice services.

In this case, Tom chose not to mention the $222 million cost.

Section 3 of HR-4994 includes the following:

Any entity that is certified as a hospice program shall be subject to a standard survey by an appropriate State or local survey agency, or an approved accreditation agency, as determined by the Secretary, not less frequently than once every 36 months beginning 6 months after the date of the enactment of this subparagraph and ending September 30, 2025.”

Funding….there shall be transferred from the Federal Hospital Insurance Trust Fund under section 1817 of such Act (42 U.S.C. 1395i) to the Centers for Medicare & Medicaid Services Program Management Account–

(A) $25,000,000 for fiscal years 2015 through 2017, to be made available for such purposes in equal parts for each such fiscal year; and 

(B) $45,000,000 for fiscal years 2018 through 2025, to be made available for such purposes in equal parts for each such fiscal year.

Tom in some cases opposes taking money from one program to fund another, but not in this case evidently.

While the technical language of the bill is confusing, it must be a good thing overall as we read in Tom’s Sept. 17 press release that President and CEO of the Hospice and Palliative Care Association of NYS, Kathy McMahon, said of the bill:

The bill’s passage supports the Hospice and Palliative Care Association of New York State’s longstanding position that the Centers for Medicare & Medicaid Services (CMS) should use the survey and medical review processes to support program integrity and ensure compliance with hospice regulations.

Here is another explanation of HR-4994:

The National Hospice and Palliative Care Organization heralds the passage of this legislation and the additional oversight it will bring to end-of-life care providers. The provisions that affect hospice providers are:

  1. Mandated surveys of Medicare certified hospice providers at least every three years for the next ten years at the minimum.
  2. Medical reviews for hospice programs with a soon to be determined percentage/number of patients receiving care for more than 180 days. The specific patient load that would trigger this medical review will be set by CMS.
  3. Hospice reimbursement and the hospice aggregate financial cap to be aligned using a common inflationary index.

I can understand why providers welcome an increase in funding, but I am puzzled why they would welcome more frequent oversight. Point 2 above is also confusing–what action might be triggered by the review?

© William Hungerford – October 2014








About whungerford

* Contributor at NewNY23rd.com where we discuss the politics, economics, and events of the New New York 23rd Congressional District (Allegany, Cattaraugus, Chautauqua, Chemung, (Eastern) Ontario, Schuyler, Seneca, Steuben,Tioga, Tompkins, and Yates Counties) Please visit and comment on whatever strikes your fancy.
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5 Responses to Hospice Act Passes House

  1. josephurban says:

    Will this IMPACT law really have much of an impact on hospice care? Or is it just a layer of bureaucracy? Found this point of view that may be of interest to others.


  2. Deb Meeker says:

    Are Tom and Friends trying to help the demise of the Federal Hospital Insurance Trust Fund along?

    “This trust fund is part A of Medicare, the United States’ health insurance program for people age 65 and older and certain disabled persons. It is financed through payroll taxes derived from current workers and employers. This trust fund is overseen by a board of trustees that report yearly to congress regarding its financial status. It has been projected to become insolvent a number of times throughout the years, due to legislative changes, and is currently projected to become insolvent in the year 2017.
    The main concern with this fund is that over time, the Nation’s economy will not support this type of program. The actual trust fund is an account mechanism, since there is no transfer of money into or out of the fund. Income to the trust fund is credited in the form of interest-bearing government securities. Expenses for services and administrative costs are recorded against the fund. If the fund has a balance, the Treasury is allowed to make payments. ”

    last financial statement I could find: click to enlarge


  3. whungerford says:

    Thank you Joseph. The article you found does suggest an answer to my question: “what action might be triggered by the review?” Heather Wilson writes: “Perhaps hospices will have a greater incentive to keep their numbers of long length of stay patients below that threshold. Will that contribute to improved quality of care? Not likely.” If as Ms. Wilson suggests, the intent of the act is to counteract some provider’s negative image, that might explain why Care First and Rep. Reed are so anxious to pat each other’s backs.


  4. whungerford says:

    Tom often objects to taking money from one program to fund another, but not when self-interest is involved.


  5. Pingback: Tom Reed’s six bills | New NY 23rd

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