Rep. Earl Blumenauer (D – Oregon) recently introduced H.R. 9803, the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act. The Center for Medicare Advocacy supports this legislation, which proposes a number of significant payment reforms and program integrity measures that aim to strengthen Medicare’s hospice benefit.
The bill would revise the payment structure for routine home care to incentivize the provision of in-person clinical visits. It also increases payments for the furnishing of palliative radiation, chemotherapy, blood transfusions and dialysis, and creates an outlier payment policy to support delivery of care to higher-cost patients. The bill would allow respite care to be provided at home, as the hospice benefit currently only covers respite care on an inpatient basis. It also creates a transitional 15-day inpatient respite period to give eligible patients and their families adequate time to arrange a safe transition into receiving hospice at home following a hospital stay, rather than being discharged to a skilled nursing facility first.
The Act would impose a five-year moratorium on the enrollment of new hospices into Medicare, with certain exceptions. This provision is meant to control the spread of fraud, waste, and abuse that has been prevalent in a few states. Other key program integrity measures include enhancing oversight of newly-enrolled hospice programs, increasing survey frequency for certain programs, and prohibiting certain changes in majority ownership. The bill disallows a physician, nurse practitioner, or physician assistant who has an employment, ownership or financial relationship with the hospice to certify a patient’s terminal illness for the initial 90-day benefit period. It provides that a hospice medical director must have an active medical license to practice in the state, and requires that the medical director or physician member of the patient’s hospice interdisciplinary group be available for immediate consultation.
A section-by-section summary of the Hospice CARE Act is available here.
October 10, 2024 – W. Kwok