Home Health & Hospice Week

Hospices’ aggregate per patient cap situation isn’t perfect, but at least it’s not a whole lot worse after Congress passed its omnibus spending bill that funds the government through Sept. 30.

Word had circulated that lawmakers were looking at using a 20 percent reduction to hospices’ cap amount to fund other priorities in the budget bill they were hammering out to avert a government shutdown. New data from the Medicare Payment Advisory Commission showing a 14.2 percent Medicare profit margin in the latest year, 2020, and a relative boom in hospice numbers, didn’t seem to be helping hospices’ case (see HHHW, Vol. XXXI, No. 45).

But in the end, the bill passed on Dec. 23 doesn’t include the cap cut.

That omission “protect[s] hospice patients and providers,” cheers the National Hospice and Palliative Care Organization in a statement about the budget package.

But a cap-related problem still exists, NHPCO contends. “The legislation extends the cap calculation methodology implemented by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014,” the trade group criticizes. “For years that measure has slowed the growth of the hospice aggregate cap, reducing the total amount a hospice can be reimbursed for care provided to patients, as compared to the rates set prior to the IMPACT Act.”

This bill “extends that IMPACT Act aggregate cap methodology by another year to 2032,” NHPCO laments. That means “that for the next decade many hospices will have to do more with less to continue providing patient care,” it says.

“Avoiding an across-the-board cap cut, while facing continued slowdown of cap growth is like two steps forward, one step back,” condemns NHPCO interim CEO Ben Marcantonio in the statement. “Forty years after the creation of the Medicare Hospice Benefit, in bleak economic times, Congress has decided to put to the next ten years of hospice care at risk by continuing to recklessly use hospice as an ATM,” Marcantonio charges.

F2F Telehealth Visits OK Through 2024

The budget package contains a number of positives for hospices, including two years of relief from 4 percent PAYGO reductions (see related story, p. 2).

And the bill allows telehealth to be used for a required face-to-face encounter prior to the recertification of a patient’s eligibility for hospice care for two more years, notes McDermott+Consulting, an affiliate of law firm McDermott Will & Emery, in a bill summary.

This is an improvement over the 2022 omnibus spending package’s extension of the flexibility for 151 days starting the first day after the end of the COVID-19 public health emergency, notes Katy Barnett with LeadingAge in the trade group’s review of the bill.

Regular hospice telehealth visits will also be allowed, NHPCO notes.

The bill expected to be signed into law by Dec. 30 also includes a provision that adds “marriage and family therapist, or mental health counselor” to the list of hospice team members effective in January 2024. “There is no requirement for hospices to use MFTs or MHCs and a social worker is still required if needed under a patient’s plan of care,” NHPCO highlights.

Hopefully, this change will “alleviate some of the recruitment issues we’ve been hearing from members,” Barnett says.

And the bill includes a provision about developing quality standards for bereavement and grief care, the trade groups report.

In summary: “This package is a mixed bag for hospices,” Marcantonio judges. “On the one hand, NHPCO members have been actively advocating for telehealth extension, against a 20 percent cap cut, and for national approaches to supporting grief and bereavement services. Those provisions are wins for patients, families, and communities across the country, as is the inclusion of marriage and family therapists and mental health counselors as part of the hospice interdisciplinary team,” he says.

“On the other hand, Congress has extended the slowdown of the growth of the hospice aggregate cap, even though the evidence shows that the seven percent reductions already implemented through the IMPACT Act have limited access to hospice care among patients with Alzheimer disease and other dementias,” Marcantonio points out.