Senate Bill Would Reallocate Nearly $1B in Hospice Funding to Pharmacy, Behavioral Health Programs

The U.S. Senate Finance Committee is holding a markup meeting today on a bill that would, among other provisions, reallocate close to $1 billion hospice dollars to other programs.

When it comes to legislation, a few words can make a big difference. A couple of sentences in a 120-page set of amendments to the Social Security Act would make adjustments to the hospice payment cap for 2033 that would free up $927 million. Congress intends to reinvest those dollars into pharmacy benefit management, behavioral health and other projects.

Stakeholders in the hospice community are lobbying for those funds to be reapplied to supporting hospice initiatives, according to Logan Hoover, vice president of policy and government relations at the National Hospice and Palliative Care Organization (NHPCO).


“The last two years that they’ve extended, [the amount] has been in the mid-$500 millions,” Hoover told Hospice News. “Essentially they’re taking money from hospice to use for other programs that’s gone from about $50 million a year to almost a billion a year — 20x. What we’re asking for this year is that some of that money goes and it’s reinvested into surveys, surveyor competency, that sort of education.”

These annual adjustments have their roots in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which changed the way the hospice aggregate payment cap is calculated. For Fiscal Year 2024, the cap is set at $33,494.01 for next year.

Since then, Congress has used funds gained from cap adjustments to shore up other programs or support additional policies. Now hospice advocacy groups are contending that the money should go to efforts to improve hospice quality. This would include implementing changes to the survey process and surveyor training that the U.S. Centers for Medicare & Medicaid Services (CMS) has been working to implement since 2022.


CMS has an extensive backlog for hospice surveys. Nearly 40% of hospices have not been surveyed within the three year timeframe, the agency reported, and a large contingent of surveyors have yet to undergo revised training processes.

“In order to pay for policies, Congress has often gone back to that [payment cap] calculation change as a source of savings to pay for other policies like making sure that physician fee schedule cuts don’t go into effect,” Mollie Gurian, vice president of home-based and HCBS policy at LeadingAge, told Hospice News. “In this case, they’re looking at mental and behavioral health provider changes, which are things that we are supportive of, but these are hospice dollars, and we have a hospice need right now.”

NHPCO, LeadingAge, the National Association for Home Care & Hospice and the National Partnership for Healthcare and Hospice Innovation have been in communication with lawmakers in hopes of keeping the funds within the hospice program.

Among their goals is obtaining additional money to assist hospices with navigating new CMS regulations, such as the establishment of a Special Focus Program for poor-performing providers, which CMS finalized last week.

“They need money to give hospices technical assistance within the Special Focus Program,” Hoover said. “We’re trying to show good faith here and saying, ‘Hey, we’re willing to dig into our own pockets here. These are hospice dollars; let’s use them to pay to improve the quality of care that’s delivered.”

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