LeadingAge Advocacy Goals
- Realize the full integration of hospice services into the continuum of care.
- Ensure appropriate reimbursement to provide quality end-of-life care.
- Promote access to and use of appropriate palliative and end-of-life care in all health and long-term care settings.
- Work for reasonable hospice regulations to allow quality, community-based care without unnecessary burdens.
Overall, hospice enjoys positive public perception from those who have received it, from the public at large, and from policymakers. However, as hospice has grown from a volunteer-driven, grassroots movement into an $18 billion portion of the Medicare program, policymakers are taking a closer look at the hospice benefit and more questions are arising regarding how to define quality hospice care and provide effective oversight. Additionally, as the complexity of illness trajectories increase and more treatment options emerge, so does the choice to go on hospice both from a policy and personal perspective. LeadingAge is engaged with policymakers both on current legislative and regulatory issues about the current benefit and how to make it accessible and of the highest quality for today, but also will engage in thought leadership on the future of hospice and palliative care needs.
Advocacy Action 2020
- Hospice Oversight: We support the Hospice Care Improvement Act of 2019 (S. 2807), which aims to improve the quality of care furnished by Medicare hospice programs through increased oversight, transparency, and education. We support portions of the House counterpart, HOSPICE Act (H.R. 5821), but do not support the addition of civil monetary penalties (CMPs) to the hospice program nor the increase in survey frequency.
- Access to Telehealth: We support the CONNECT for HEALTH Act of 2019 (S. 2741/H.R. 4932) to amend Medicare to expand access to telehealth, including the provision that allows the hospice face-to-face recertification to take place via telehealth.
- Training in Palliative Care: We support the Palliative Care Education and Training Act (PCHETA; S. 2080/ H.R. 647) which would provide professional training in palliative care and has passed the House.
- Palliative Care Access: We support the Provider Training in Palliative Care (S. 1921) to allow the definition of primary care provided by the National Health Service Corps to include palliative care services.
- Rural Health Clinics and Hospice: We support the Rural Access to Hospice Act (S. 1190/H.R. 2594) to amend the Social Security Act to provide payments for certain rural health clinics and federally qualified health center services provided to hospice patients under Medicare.
- Older Americans Act Reauthorization: We support the reauthorization of Older Americans Act (Dignity in Aging Act; H.R. 4334) to include provisions focused on serious illness. The Dignity in Aging Act (H.R. 4334) has passed the House and been introduced in the Senate.
- Advanced Illness Care: We support the Removing Barriers to Person Centered Care Act (S. 829) to award cooperative agreements to improve care for individuals with advanced illness.
- Physician Assistants: We seek a legislative fix to the statute that does not allow for PAs to provide face-to-face encounters. We also seek to provide clarity around the role of physician assistants in hospice.
- Integration of Hospice and Palliative Care into the Continuum of Aging Services: We seek legislative provisions that would enable such integration.
- Value-Based Payment: We will engage with the Center for Medicare and Medicaid Innovation (CMMI) on the Value-Based Insurance Design (VBID) Model – Hospice Track and provide education for our members.
- HOPE Tool: We will continue Hospice Outcomes and Patient Evaluation (HOPE) tool development and assessment process engagement.
- Oversight Reforms: We will engage with the CMS Center for Clinical Standards and Quality as they consider oversight reforms in light of Office of Inspector General (OIG) reports and pending legislative changes.
- Hospice Wage Rule: We will review and provide comments on the FY 2021 Medicare Hospice wage rule.
- Center for Medicare and Medicaid Innovation (CMMI):
- We will engage with CMMI on the Value-Based Insurance Design (VBID) Model – Hospice Track and provide education for our members.
- We will monitor and engage with CMMI as needed on the Primary Care First and Direct Contracting models.
- We will monitor participation in the Kidney Care Contracting Model regarding the benefit enhancements, particularly allowing concurrent care for those who elect hospice.
- MedPAC: We will monitor MedPAC activity, including a proposal to wage adjust and lower hospice aggregate cap.
Actions You Can Take Now
- Visit the Advocacy Action Center to let your representative and senators know that you support quality hospice and palliative care.
- Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact hospice and palliative care.
- Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support more opportunities to provide quality hospice and palliative care services.
- LeadingAge summary and letter to Ways and Means on the HOSPICE Act (H.R. 5821)
- Nonprofit Hospice Services: Where Mission and Community Meet
- Hospice Medicare Margins: Analysis of Patient and Hospice Characteristics, Utilization and Cost
- LeadingAge Comments on FY2020 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- LeadingAge FY 2020 Hospice Rate Calculator (Members Only)
- Opportunities to Strengthen CMS Oversight of Hospice Providers (GAO)
- Safeguards Must Be Strengthened To Protect Medicare Hospice Beneficiaries From Harm (OIG)
- Hospice Deficiencies Pose Risks to Medicare Beneficiaries (OIG)
- Registered Nurses Did Not Always Visit Medicare Beneficiaries Homes At Least Once Every 14 Days To Assess The Quality of Care And Services Provided By Hospice Aides (OIG)