Hospice Industry Groups Lobbying Congress to Change CMS’ Special Focus Program

The four largest hospice industry organizations are urging congressional lawmakers to mandate changes to the Special Focus Program (SFP) currently set to begin in 2024.

The U.S. Centers for Medicare & Medicaid Services (CMS) last week issued its 2024 home health payment rule, which contained several hospice provisions. Among them was the Jan. 1 implementation date for the SFP.

Though the hospice community generally has voiced support for the program, many contend that the agency’s methodology for identifying hospices for the SFP is deeply flawed. Stakeholders, including hospice providers and members of Congress, have called on CMS to postpone the program and revise that algorithm.


Now, industry groups are lobbying Congress to include updates to the SFP in forthcoming spending bills that must be passed by a Nov. 17 deadline, including the National Hospice and Palliative Care Organization (NHPCO), the National Association for Home Care & Hospice (NAHC), LeadingAge and the National Partnership for Healthcare and Hospice Innovation (NPHI).

The SFP, as currently designed, would not effectively fulfill its goals of improving hospice quality, according to Ethan McChesney, policy director for NPHI.

“The four hospice organizations are working multiple legislative angles to address concerns related to the SFP algorithm given CMS’s decision to finalize it as proposed without regard for the issues raised by stakeholders, bipartisan Congressional leaders and providers,” McChesney told Hospice News in an email. “Our position is that contrary to Congressional intent, the final SFP design will not support hospices’ quality improvement, and will reduce access to higher-quality care by directing patients and families to hospices that perform more poorly on health and safety requirements.”


The industry groups are asking Congress to devote additional funds to hospice surveyor education and training, require technical changes to the algorithm, give providers in the program technical assistance to improve compliance and to mandate that the SFP send hospices a preview report with an opportunity to contest their quality scores.

They have also called on legislators to require the Government Accountability Office (GAO) to report on the SFP’s implementation for the purposes of improving the program, according to McChesney.

NHPCO, NAHC, LeadingAge and NPHI made similar requests during the public comment period for the home health rule, but CMS did not implement any of their recommendations.

In addition, four members of Congress made similar requests to CMS, including Reps. Beth Van Duyne (R-Texas), Earl Blumenauer (D-Ore.), Jimmy Panetta (D-Calif.) and Brad Wenstrup (R-Ohio).

Nevertheless, CMS made no changes to its proposed methodology.

“Per our previous recommendations, we’d really like to see an SFP algorithm that scales survey data by hospice size, reweights [Consumer Assessment of Healthcare Providers and Systems (CAHPS)] data to more accurately account for the huge number of hospices that do not report on these measures, provides SFP hospices with real technical assistance to help them improve their quality, and gives hospices preview reports of their scores under the SFP so they can better understand where there are gaps and take steps to shore them up,” Davis Baird, director for government affairs for hospice at NAHC, told Hospice News in an email. 

The industry groups have also requested greater transparency from CMS on the state of its hospice survey backlog and the agency’s plans to address it, according to Baird.

Nearly 40% of hospice providers have not undergone a survey within the past three years, CMS has reported. This is critical as survey results are a key factor in the agency’s SFP algorithm.

Congress mandated the SFP in the Consolidated Appropriations Act of 2021, which contained language from the Helping Our Senior Population in Comfort Environments (HOSPICE) Act. This was in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) in the U.S. Department of Health and Human Services (HHS).

The program will have the authority to impose enforcement remedies against hospices with poor performance based on its algorithm. Hospices flagged by the SFP also will be surveyed every six months rather than the current three-year cycle and could face monetary penalties or expulsion from the Medicare program.

CMS will also make public the names of hospices selected for the SFP, putting a “Scarlet Letter” on providers who may be in the program as a result of flawed data, Logan Hoover, vice president of policy and government relations at NHPCO, told Hospice News.

“If we’re identifying the wrong hospices, that could have some mere ramifications for those providers in terms of their enrollment numbers, in terms of ability to recruit new staff and to retain the staff they have,” Hoover said. “That could potentially push patients away from not just a good provider, but [also] potentially towards one that might not deliver that same quality of care.”

Time is of the essence when it comes to potential congressional remedies. If lawmakers take up the SFP issue, they would most likely insert language into an existing funding bill rather than introduce separate legislation. This is a common practice in Congress.

However, the deadline for passing those bills is coming up fast, Mollie Gurian, vice president of home-based and HCBS policy at LeadingAge, told Hospice News.

“Given the pending congressional deadlines, they have to do something to fund the government by Nov. 17,” Gurian said. “We don’t know what opportunities will be available after that for a potential legislative fix. We’ve been working together to promote among our congressional allies the urgency of doing this now.”

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