HOSPICE Act Would Increase Survey Frequency, Redesign Surveyor Training

Recently introduced legislation in the U.S. House of Representatives calls for increasing the frequency of hospice compliance surveys to every two years as opposed to the current policy of every three years. Among other provisions, the bill would also take steps to improve surveyor education and training.

Reps. Jimmy Panetta (D-Calif.) and Tom Reed (R-N.Y.) earlier this week introduced the Helping Our Senior Population in Comfort Environments (HOSPICE) Act, designed to bolster regulatory enforcement in response to two July 2019 reports from the U.S. Department of Health and Human Services Office of Inspector General (OIG).

Increasing survey frequency is one of the centerpiece provisions of the bill, in addition to revamping the surveyor training process and making available to the public results of surveys by state agencies, the U.S. Centers for Medicare & Medicaid Services (CMS) and accreditation organizations.


“The [Secretary of Health and Human Services] shall provide, not later than October 1, 2021, for the comprehensive training of state and federal surveyors in the conduct of surveys under this subsection, including training with respect to the review of written plans for providing hospice care,” the legislation proposes. “No individual shall serve as a member of a survey team with respect to a survey conducted on or after such date unless the individual has successfully completed a training and testing program in survey and certification techniques that has been approved by the secretary.”

The Congressional Budget Office projects that the legislation, if enacted as written, would reduce direct Medicare spending by $23 million by 2025 and $129 million between 2020 and 2030, according to a preliminary estimate. The Senate is considering a similar bill, the Hospice Care Improvement Act, that was introduced last November.

Stakeholders in the hospice community have expressed support for the surveyor training portion of the bill, though some have voiced concern about provisions that would increase survey frequency, citing the increased burden that would impose on providers.


“We are particularly encouraged to see that the legislation includes concrete steps to make the results of quality surveys by states and accrediting organizations more transparent to consumers in an accessible and understandable way; a requirement that CMS measure and reduce inconsistency in the application of survey results across states; more training for hospice surveyors, including dedicated funding; and enabling the [Secretary of Health and Human Services] to take action quickly in cases where beneficiaries are in immediate jeopardy of harm from poor-quality care,” Tom Koutsoumpas, president and CEO of the National Partnership for Hospice Innovation, said.

Organizations that include the National Hospice & Palliative Care Organization (NHPCO), the National Association for Home Care & Hospice, and LeadingAge also praised the surveyor education piece, while raising questions about other aspects of the bill, such as proposed civil monetary penalties for some instances of noncompliance.

“One encouraging thing about the House legislation is that it does tackle one of the current problems in the status quo, and that is lack of surveyor education. If the oversight is being done by folks who don’t know hospice rules and regulations, it’s not effective oversight,” Edo Banach, president and CEO of NHPCO, told Hospice News. “If you spend your days serving home health agencies or nursing homes, and then suddenly you’re asked to go survey a hospice, you should know what you’re doing.”

Public reporting of survey results from regulators as well as accreditors like The Joint Commission, Accreditation Commission for Health Care and Community Health Accreditation Partner would be a significant move. If enacted, the legislation would require CMS to publish such information in a manner that is prominent, easily accessible, readily understandable and searchable. This may be a challenge for the agency, which would have to distill complex and somewhat arcane quality information in a way that would make sense to the public and other stakeholders. 

The bill will almost certainly be revised as it moves through the legislative process, including committee markups. Hospice organizations will be lobbying for changes that would reduce the potential burden on providers and redesign the bill to focus on bad actors in the hospice space rather than providers at large.

“The details are crucial. I think that the finished bill the legislation that incorporates the feedback that NHPCO and others have provided, as well as melds together the House and the Senate versions will probably look a bit different than the one that we see today,” Banach said. “Front and center, we want to make sure that we don’t hinder access to high quality care for patients and families.”

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