Election 2020: The Stakes for Hospice, Palliative Care

With the election looming, both Republican President Donald Trump and Democratic Candidate Joe Biden have taken positions that could reshape Medicare for the foreseeable future. From the conservative camp’s calls to repeal the Affordable Care Act to Biden’s proposal to lower the eligibility age, the outcome of the election could change some of the ways hospices do business.

Also on the table is the question of which of the temporary regulatory flexibilities instituted during the COVID-19 pandemic will be made permanent, such as those that expanded telehealth services.

“Crisis creates urgency in this environment that we are now in, where people have suddenly adopted telehealth from the member or plan perspectives, and from physicians suddenly having this flexibility to use all kinds of platforms,” said Romilla Batra, M.D., chief medical officer, SCAN Health Plan, during the Coalition to Transform Advanced Care (C-TAC) National Summit on Advanced Illness Care. “We have adoption happening from all ends. We have this perfect storm that we can galvanize, and we just have to keep it going. This is the right moment if we have the right policy set up on time.”

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The U.S. Centers for Medicare & Medicaid Services (CMS) is reviewing the temporary telehealth rules to determine which will be made permanent.The number that would impact hospice remains unseen.

With COVID-19 shifting more care into the home setting, the pandemic is putting a spotlight on the growing need for in-home support services for the seriously or chronically ill, including community-based palliative care. 

A number of stakeholders have said that the time is right to expand a community-based palliative care benefit, with efforts underway among providers, payers, advocacy groups and state governments to make home-based care more accessible.

Many hospice providers are already offering palliative care, with the Center to Advance Palliative Care (CAPC) reporting last year that at least half of in-home palliative care providers in the United States were hospices.

The outcome of the upcoming election could impact the trajectory of the Medicare Advantage program and other value-based payment models. Hospices will be able to participate in the Medicare Advantage program for the first time in 2021, through the value-based insurance design model demonstration.

Law requires Medicare Advantage plans to cover all of the services offered by traditional Medicare, but also allows for certain supplemental benefits. Historically these benefits were very limited, but the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act (CHRONIC), passed by Congress in 2018, expanded the range of those benefits to include programs to address some social determinants of health as well as home-based palliative care.

Whichever administration takes office following the election, policy changes and evolving payment models are expected to continue shaping where and how hospices can provide palliative care in coming years.

“We are living in a time of just extraordinary innovation,” said Andrew MacPherson, C-TAC’s senior policy advisor and managing partner at Healthsperien, LLC during the C-TAC summit. “Regardless of the outcome on [Election Day] there is progress. The value-based models of care models of care were only really in developmental stages 10 years ago, are now being implemented by CMS and across the private sector all over the country. Also, look at the explosive growth of in-home supports for the medically complex populations in Medicare Advantage, including home-based palliative care and advanced care planning.”

Some potential changes could be even more fundamental. Former Vice President Biden proposes to lower the age of eligibility from 65 to 60, which would give access to the Medicare Hospice Benefit to a much larger population.

Both candidates have pledged changes to the Affordable Care Act, with Trump calling for the law’s repeal and Biden laying out plans to enhance its existing structure.

 “No matter who is in power in 2021, as [the election] relates to Medicare, let’s see what happens to the Affordable Care Act,” , said Robert Blancato, executive director of the National Association of Nutrition and Aging Services Programs (NANASP) and president of Matz, Blancato & Associates firm. “Is it getting replaced or will it get rebuilt stronger? Might we move from ‘Medicare for all’ to ‘Medicare for more’ by lowering the eligibility age? Will Medicare Advantage continue to grow?”

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