The hospice community is contributing input to the development of the forthcoming Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act.

Rep. Earl Blumenauer (D-Oregon) is in the process of drafting the bill that, if enacted, would represent the most significant reforms to date for hospice payment and oversight. The legislation is currently in a discussion draft phase, which has been circulated among the nation’s major industry trade associations and their members for feedback.

Blumenauer announced the bill at the Hospice News Elevate conference in Washington D.C. There, the Congress member pledged to work with hospice providers to fine turn the bill’s language.

“I’ve issued a discussion draft on legislation that helps incorporate what seemed to be simple, common sense items we want circulating,” Blumenauer told Hospice News at Elevate. “We want people to be able to critique it … working with you to make it function better.” 

Though the bill and the organizations’ comments are extensive, a key feature of the legislation is proposed changes to the hospice per diem payment system.

Among the changes would be a reduction in hospice daily rates and the addition of a per-visit payment for clinical services to ensure that hospices are delivering appropriate care to patients.

To date, the hospice community’s response to the proposed payment changes have been mixed, with some affirming the need for change, others voicing opposition and still others who have called for the draft provisions to be revised with greater detail.

The National Partnership for Healthcare and Hospice Innovation (NPHI), a consortium of nonprofit providers, acknowledged a need to revise the current payment model.

“NPHI has consistently advocated for reform to the Medicare hospice benefit reimbursement methodology. We believe the current payment framework is outdated, encourages manipulation, and does not adequately reimburse the providers caring for the most complex patients,” the organization indicated in a comment letter shared with Hospice News. “As such, we welcome Congressman Blumenauer’s proposal to address these challenges via the proposed reforms to the routine home care payment.”

Joint comments on the bill came from the National Hospice and Palliative Care Organization (NHPCO) and the National Association for Home Care & Hospice. The two organizations recently completed a merger and are in the process of integration, currently operating as the NAHC-NHPCO Alliance.

The alliance opposes the proposed changes, urging lawmakers to exercise caution when implementing such a significant overhaul of the way hospices have operated since the inception of the Medicare benefit.

“A fundamental overhaul of the entire hospice payment rate setting process would be a transformative change for the hospice community, and as such, much more data, modeling and analysis needs to be available and completed before transitioning away from the current system,” the NAHC-NHPCO Alliance indicated in a comment letter. “There is no way to ascertain what impact this change would have on hospices or patients and families. … We should be extremely cautious about making major changes to a system that works extremely well for the vast majority of patients and take small, targeted approaches to improve the system in cases where it is not working.”

The senior services advocacy group LeadingAge voiced support for “the intent” of the reforms, but likewise suggested that more information is necessary before lawmakers can decide on an effective course of action. For example, providers need to know which visits from members of different clinical disciplines would be billable.

Changes to other processes, such as cost reports, may also be necessary in order to implement a fundamentally different payment model, according to a comment letter from LeadingAge. Cost reports could form the basis for setting payment rates in a new model, but many providers contend that a good number on them are inaccurate.

“People couldn’t commit [to the payment reforms] either way, because, generally, because it’s a big change, and in a month aren’t really able to model what per-visit payment might mean for them,” Mollie Gurian, vice president of home-based and HCBS policy at LeadingAge, told Hospice News. “Our members feel like they do a lot under their per diem, but they certainly see others in their community who do a lot less. So they definitely understood the concern and agree that payment reform is probably needed. But as to whether per- visit is the right answer, the jury is still out.”

The bill is still in draft form and has yet to be introduced in Congress. After introduction occurs, it will have to wind its way through the legislative process, including committee markups.

Questions and concerns like these are not unexpected, Blumenauer indicated at Elevate, but he reiterated that some type of reform is essential.

‘It’s time to take a hard look at what we’re doing with the per diem system. Unfortunately, it’s possible for people to gain that system and not actually provide the services,” Blumenaur said. “We have elements here that we want to make sure that families and patients are confident that the service is actually being delivered. I know it’s going to have a modest amount of controversy, but I think it’s something that’s long overdue and is important.”