House Approves Bill to Update CMS Hospice Oversight

The U.S. House of Representatives has passed the Beneficiary Enrollment Notification and Eligibility Simplification Act of 2019 (BENES). While the main focus of that bill relates to Medicare eligibility and enrollment, it would also change the frequency of regulatory hospice surveys to every two years instead of every three years, among other provisions.

The legislation contains language originally written for the Helping Our Senior Population in Comfort Environments (HOSPICE) Act, including the establishment of civil monetary penalties for hospices demonstrating certain deficiencies. The hospice sections were designed to strengthen regulatory oversight of providers in the wake of two July 2019 reports from the U.S. Department of Health and Human Services Office of Inspector General (OIG).

Industry stakeholders have voiced a number of concerns about the bill, arguing that remedies should be focused on organizations that have a history of serious deficiencies rather than the hospice community as a whole.

“OIG clearly indicated that there are problem providers and that efforts should be targeted to those bad actors,” Theresa Forster, vice president for hospice policy and programs for National Association for Home Care and Hospice (NAHC), told Hospice News. “We are also concerned about the civil monetary penalties; similar actions have not gone well in the past.”

The OIG 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 CMS enforcement strategies.

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.

Increased survey frequency would be an expensive proposition for providers and could cause significant disruption for hospices.

“It would be costly for all in terms of time and resources, including the surveyors who are already swamped themselves,” said Mollie Gurian, director of hospice, palliative and home health policy for LeadingAge. “The data on which the OIG reports were based was mostly from before the IMPACT Act so they don’t reflect the effects of the mandatory surveys every 36 months.”

The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) required health care providers to submit standardized patient assessment data with regard to quality measures and standardized patient assessment data elements, among other rules.

In addition to survey frequency and penalties, the BENES Act also retains language from the HOSPICE legislation that would require the public reporting of hospice accreditation survey results, which most accrediting agencies oppose. These survey reports can be very technical and most members of the public would likely have difficulty interpreting the information.

Having passed the House, the bill will now go to the Senate for revision and consideration. Two senators, Rob Portman (R-Ohio) and Ben Cardin (D-Md.), released a statement in support of the hospice provisions shortly after the bill cleared the House.

“Now that the House has passed legislation to increase transparency and patient safety in hospice, the Senate must also act before the end of the year,” said Cardin in the statement. “Families in need of hospice care should be able to concentrate on the comfort and care of their loved one without the worry of unacceptable safety and medical standards.”

Some potential bright spots in the legislation include actions intended to improve the CMS survey process as well as provide additional education to surveyors that inspect hospices. The National Hospice & Palliative Care Organization (NHPCO), LeadingAge and NAHC have expressed support for those portions of the bill.  

“NHPCO supports smart oversight when it does not hinder access to high-quality care for patients and their families,” said NHPCO President and CEO Edo Banach. “Hospice providers that are following the rules should not be subjected to excessive administrative burden and forced to needlessly divert resources from patient care.”