Rep. Earl Blumenauer (D-Oregon) has introduced the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act in the U.S. House of Representatives, which, if enacted, could revolutionize the Medicare Hospice Benefit.

Blumenauer announced that his office was working on the bill at the Hospice News Elevate conference in Washington D.C. The bill includes an overhaul of the per-diem payment system, along with a slew of other regulatory updates and changes to the benefit.

“This is an opportunity to do something in this Congress that is concrete, specific, that will save money and improve the quality of care for some of our most vulnerable people …” Blumenauer told Hospice News at Elevate. “This is an essential part of being able to humanize the health care system to improve patient outcomes.”

The bill would also implement a temporary, national moratorium on the enrollment of new hospices into Medicare, to help stem the tide of fraudulent activities among recently established providers concentrated primarily in California, Arizona, Texas and Nevada.

Among the key 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.

“The United States spends significantly more on health care than other developed nations for worse outcomes. Nowhere is this more egregious than in the hospice industry,” Blumenauer said today in a statement. “Patients and families deserve better. We need a reset. It is past time for Congress to act to end the fraud, waste, and abuse within the hospice benefit and bring it into the 21^st century.”

The bill would also institute a payment add-on to support delivery of higher-acuity care palliative services that are difficult for hospice to support within the current payment structure. In the current draft of the legislation, this would include dialysis, chemotherapy, radiation and blood transfusions.

It also proposed changes to the ways hospices provide respite care, including the allowable lengths of stay within that level of care.

Stakeholders in the hospice space have welcomed the bill, though some disagreed with some of the provisions included in the discussion draft, including the proposed payment reforms. At this point, it remains to be seen whether changes were made to the version that Blumenauer ultimately introduced.

The newly formed National Alliance for Care at Home on Thursday called the bill “an opportunity to advance hospice benefit discussion.” The Alliance is the combined organization formed by the merger of the National Hospice and Palliative Care Organization (NHPCO) and the National Association for Home Care & Hospice (NAHC).

“The Alliance shares Rep. Blumenauer’s desire to update the Medicare hospice benefit to address the evolving needs of our country’s aging population while ensuring the sustainability and integrity of the hospice program …” the organization indicated in a statement shared with Hospice News. “The Alliance appreciates Rep. Blumenauer’s commitment to involving a diverse group of stakeholders in developing this legislation and will continue to work closely with congressional leaders on the finer points of the proposed bill to ensure that the final legislation supports the needs of patients, families and providers alike.”

The senior services advocacy group LeadingAge told Hospice News in an email that the Medicare benefit is due for reform. 

“The hospice benefit, while unique, is ripe for change. This legislation is a first-of-its-kind opportunity to improve it,” Katie Smith Sloan, president and CEO of LeadingAge said in a statement. “Revising a benefit that has not been altered significantly since its creation in 1982 is a formidable undertaking – but a necessary one. Done right, changes will expand the benefit to support the realities of modern-day hospice care and address vulnerabilities that are currently being exploited and help ensure quality to support strong funding. There is more work to do, and we look forward to continuing our productive partnership to ensure this bill achieves these goals.”

Each of the three largest hospice industry groups has pledged to work with Blumenauer’s office to help fine tune the bill’s language, including the Alliance, LeadingAge and the National Partnership for Healthcare and Hospice Innovation (NPHI)

“This legislation is an encouraging and unique opportunity to consider reforms that would strengthen the Medicare hospice benefit by ensuring it continues to support patients, families and the non-profit providers who were the original foundation of hospice care,” said Tom Koutsoumpas, CEO and founder of NPHI, in a statement emailed to Hospice News. “We look forward to continuing to work closely with Congress and relevant stakeholders on efforts to modernize the hospice benefit and improve care of those at the end-of-life.”