June 1, 2023 Washington, DC — Statement from Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services, including hospice, elaborating on comments LeadingAge submitted May 30, 2023 to the Center for Medicare and Medicaid Services (CMS) on FY 2024 proposed hospice wage index and payment rate update and hospice quality reporting requirements (CMS-1787-P):
“Ensuring the availability of holistic, patient- and family-centered compassionate care is critical. Fair payment that covers the cost of care is a reasonable expectation. The proposed 2.8% payment rate increase is simply not sufficient to meet providers’ needs. In the FY2022 final rule, CMS reviewed cost pressures and raised the final rate to 3.8%. Since then, our mission-driven, nonprofit members’ costs have only risen. Consider, too, that demand for hospice services is growing because of our country’s rapidly aging population. We urge CMS to recognize the financial impact of both continued workforce shortages and inflation-driven operating expense increases on providers. Rates must be adjusted to ensure providers have a fighting chance to recruit and retain workers in a highly competitive employment market. Without staff, there is no care.
Our members are committed to the practice of hospice in keeping with its founding principles as a widely accessible community service. At the same time, updates to approach and regulation are needed. We strongly encourage CMS to consider the 34 recommendations we submitted earlier this year in collaboration with other hospice associations as well as our hospice benefit reform ideas presented to members of Congress in January 2023 to ensure program integrity remains the top priority of the industry.”
Key recommendations included in LeadingAge’s May 30, 2023 comments to CMS:
- In response to CMS’ questions regarding barriers to hospice access and regarding utilization of certain therapies, LeadingAge recommends that CMS bring together experts (through a technical expert or other mechanism) to review common therapies that are barriers to hospice and provide some consensus recommendations on definitions. For instance, what constitutes “palliative” in intent, “life prolonging” or “curative” ? Once determined, local coverage determinations and regulatory guidance should be updated accordingly.
- In response to CMS’ questions regarding low utilization of the higher levels of care, LeadingAge underscores that CMS payment and enforcement policy were not aligned to create the appropriate incentives to utilize the non-routine levels of care. LeadingAge recommends CMS undertake a stakeholder engagement process to identify where the gaps in understanding regarding GIP eligibility lie – both with providers and with contractors. After this review, CMS should issue new clarifying guidance and offer education to all stakeholders. In addition, LeadingAge also asks that CMS develop either a modifier that would allow a hospice to bill CHC on a second “day” or allow a “day” to be any 24-hour period.
- To ensure parity and provide actionable data for future policymaking, LeadingAge asks that CMS implement a modifier or G-code and create a field on the hospice claim for telehealth visits from any discipline to more accurately represent the full range of visits that hospices provide and to allow telehealth costs to be considered an allowable administrative cost on the hospice agency cost report.
- In response to CMS’ proposal regarding restricting what physicians could conduct hospice certifications, LeadingAge asks CMS to review existing data on hospice referrals from non-Medicare enrolled physicians and present those findings in future rulemaking. We also ask that CMS review the administrative burden on hospices, not just physicians, and include this information in future rulemaking. Allowing the stakeholder community to see this information and provide feedback is essential to making informed policy decisions that improve program integrity without creating unnecessary barriers to services.
