Bipartisan Senate Bill Would Create Community-Based Palliative Care Demo

Four U.S. senators have introduced bipartisan legislation that would direct the Center for Medicare & Medicaid Innovation (CMMI) to develop a demonstration of a community-based palliative care payment and delivery model. Sens. Jacky Rosen (D-Nev.), John Barrasso (R-Wy.), Tammy Baldwin (D-Wisc.) and Deb Fisher (R-Neb.) are sponsoring the Expanding Access to Palliative Care Act.

The senators have also put forth the Improving Access to Transfusion Care for Hospice Patients Act of 2021, which would allow hospices to bill Medicare for transfusion services separate from their usual per diems. Proponents of the bill argue that the ability for patients to receive transfusions during their final days is essential to maintaining their quality of life. While hospices currently can cover transfusions, the costs are substantial.

“As someone who stepped away from my career to care for my parents and in-laws as they aged, and as a co-founder of the Senate’s Comprehensive Care Caucus, I have an insight into the challenges that seniors and families face when dealing with palliative or hospice care,” said Rosen. “This package would also reduce barriers to hospice care for seriously ill patients who rely on blood transfusions to maintain quality of life.”

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The bill’s four co-sponsors are founding members of the Senate Comprehensive Care Caucus, which was established in 2019 to pursue legislation actions to raise awareness of palliative care, promote utilization, improve care coordination, support caregivers and expand access to services.

Hospices provide about 50% of home- and community-based palliative care in the United States according to 2019 research by the Center to Advance Palliative Care (CAPC). Providers have seen a rise in demand for palliative care during the COVID-19 pandemic.

Additionally, more patients and families are also seeking serious illness care in their homes — a trend that began in earnest long before the pandemic, but the pace has accelerated.

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“This legislation is an important step forward in the broader effort to more fully integrate palliative services into home- and community-based settings,” said National Association of Home Care & Hospice President Bill Dombi. “By testing a more sustainable method of payment, this demonstration model would help ensure that providers across the care continuum, including hospices and home health agencies, have the support they need to increase access to high-quality palliative care for the patients and families they serve.”

In addition to the benefits for patients and families, home-based palliative care could reduce societal health care costs by $103 billion nationwide within two decades, the nonprofit economic research group Florida TaxWatch reported in 2019.

Currently Medicare reimburses for palliative care physician and licensed independent practitioner services through fee-for-service payment programs that often do not sufficiently support the full range of interdisciplinary care.

The closest existing equivalent to a palliative care benefit is the U.S. Centers for Medicare & Medicaid Services’ (CMS) test of the Medicare Care Choices Model (MCCM), which allows hospice patients to receive curative care concurrently with hospice. The agency recently announced that it was extending the program by one year. The test was originally scheduled to close at the end of 2020.

A new CMMI demonstration would likely contain elements pioneered through the MCCM.

“The time is now for CMMI to build off the successes of its Medicare Care Choices Model to establish clear criteria for core community-based palliative care services in the United States and improve access to needed care for Medicare beneficiaries experiencing serious illness in our most vulnerable communities,” National Hospice & Palliative Care Organization President and CEO Edo Banach said.

The U.S. Centers for Medicare & Medicaid Services (CMS) has dipped its toes into palliative care coverage, but the agency has stopped short of creating a dedicated benefit. CMS in 2020 began allowing Medicare Advantage plans to cover palliative care as a supplemental benefit.

Recent analysis by the consulting firm ATI Advisory indicated that the number of Medicare Advantage plans offering home-based palliative care coverage jumped to 134 in 2021, up from 61 last year. Other supplemental coverage such as in-home support services, meal programs and social needs benefits also saw a substantial rise.

Additionally, CMS is currently testing the inclusion of hospice in Medicare Advantage through its value-based insurance design model demonstration. Often called the Medicare Advantage hospice carve-in, this demonstration is driving many hospice providers to diversify their services to include more upstream care. Only 53 Medicare Advantage health plans are participating in VBID during 2021, but that number is expected to grow in subsequent years.

“Approximately 6 million people in the United States could benefit from palliative care and are not receiving it,” said Amy Melnick, executive director of the National Coalition for Hospice & Palliative Care. “This bi-partisan bill signals to [CMS] that the time has come to test a national model of care that focuses on improving the quality of life for people living with serious illness,”

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