Congress to Tackle Hospice Quality in New Legislation

Reps. Jimmy Panetta (D-Calif.) and Tom Reed (R-N.Y.) have introduced bipartisan legislation designed to strengthen regulatory oversight of hospice providers in the wake of two July 2019 reports from the U.S. Department of Health and Human Services Office of Inspector General (OIG).

The reports garnered widespread media attention and elicited strong reactions from hospice organizations. In addition to bringing attention to safety incidents in hospices, the reports called into question the effectiveness of the U.S. Centers for Medicare & Medicaid Services’ (CMS) enforcement strategies.

The new bill — the Helping Our Senior Population in Comfort Environments (HOSPICE) Act — is expected to address some of OIG’s recommendations for stronger enforcement.


“Hospice patients, family members, and caregivers should have the confidence that their hospice is a safe environment during an already difficult time. My bill will provide for improved transparency to give a clear-eyed view of the quality of care provided by all hospices,” Panetta said in a statement. “Most hospices are compassionate caregivers who are deeply concerned for their patients and families. But, there are some that can neglect and even abuse patients. This bipartisan legislation will hold those bad actors accountable, enhance the integrity of the entire hospice program, and improve the quality of care for patients in the last stages of life.”

The HOSPICE Act is designed to bring hospice oversight in line with that of other post-acute care settings by providing the U.S. Department of Health and Human Services with new powers to oversee and penalize hospices that found to have serious quality deficiencies, develop more stringent CMS and state agency surveys and improve surveyor training, as well as increase transparency for patients and families, including a requirement that states establish toll-free hotlines through which families could report abuse or neglect. 

A similar bill, the Hospice Care Improvement Act, was introduced in the Senate last November.


“When my mother became sick, there was nothing I wouldn’t have done to cure her, but she taught me that what truly mattered to her was comfort and time spent with her family. Surrounded by a wonderful team of hospice care providers, we watched as her wishes were met,” Reed said. “However, we must hold bad actors in the caregiver community accountable, and I am proud to co-lead this legislation to demand additional oversight and transparency of Medicare hospice providers.”

The first of the July OIG reports indicated that about 20% of hospices surveyed by regulators or accreditors between 2012 and 2016 had a condition-level deficiency that posed a serious safety risk. A second report detailed a dozen instances of the most serious deficiencies.

The HOSPICE Act co-sponsors Panetta and Reed are members of the House Ways and Means Committee, which has sole jurisdiction over the Medicare Hospice Benefit, according to Panetta’s office. The committee in August sent a letter to CMS Administrator Seema Verma seeking answers on how the agency would respond to the reports.

Stakeholders in the hospice space were quick to respond to the legislation, generally supporting the educational and survey improvement aspects while expressing concerns about provisions that would penalize or increase the regulatory burden on hospices.

“This, along with the Senate bill, is an attempt by by the Congress to target oversight and to make sure that we’re really addressing some of the the quality and the performance issues that we see, and we support that fully,” Edo Banach, president and CEO of the National Hospice & Palliative Care Organization (NHPCO), told Hospice News. “Front and center we want to make sure that we don’t hinder access to high-quality care for patients and families. We want to make sure that we sort of balance access to care with reduction unnecessary burden on providers that are compliant and doing the right thing year in and year out. Increased burden for providers that are not compliant is completely appropriate and that’s where of our attention should be.”

The National Association for Home Care & Hospice (NAHC) voiced support for some of the provisions to improve quality and called on Congress and regulators to consider input from hospice providers as the legislation develops.

“It is essential that a wide variety of interested parties be involved in this process in order to ensure development of the proper set of reforms to effectively respond to the OIG’s findings,” the industry group said in a statement. “NAHC believes that the provisions to improve the quality and consistency of the hospice survey process through required training and testing of surveyors, as well as the requirement that [CMS] and the states develop processes to measure and reduce inconsistency in the application of survey results will go a long way toward providing the type of care that patients at the end of life deserve.”

LeadingAge, an advocacy group on issues affecting seniors, voiced concerns that financial penalties could have a particularly detrimental impact on nonprofit providers.

“We support the aspects of this bill that aim to improve quality of care and provider oversight, including upgrades to surveys and surveyor education, as well as requirements that will give consumers greater clarity about the care they are receiving,” said Katie Smith Sloan, president and CEO, LeadingAge and acting president and CEO, VNAA/EH. “However, we cannot support all aspects of the HOSPICE Act as drafted. The inclusion of civil monetary penalties (CMPs) are an unnecessary and overly burdensome remedy for the hospice community in combination with the other elements this legislation provides to improve both regulatory oversight and consumer education.” 

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