Reps. Beth Van Duyne (R-Texas) and Jimmy Panetta (D-California) have introduced a bill that would reform aspects of the hospice Special Focus Program (SFP).

If enacted, the Enhancing Hospice Oversight and Transparency Act also would increase the penalty for hospices that do not report quality measure data to 10% by 2027, up from 4% currently.

The SFP has 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.

The newly introduced House bill is designed to improve data transparency when it comes to the hospice SFP and quality measures.

“When it comes to end-of-life care, you only have one chance to get it right,” Van Duyne said in a statement emailed to Hospice News. “I’m grateful for Congressman Panetta’s partnership as we work to address the rampant fraud and abuse in the hospice benefit that breaches trust between patients, families and the medical community. In addition to jeopardizing access to care, fraudsters have stolen millions of taxpayer dollars which is why we’re working to provide accountability, restore integrity to the hospice benefit and ensure access to compassionate, high-quality care.”

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).

CMS will make public the names of hospices selected for the SFP. However, the Van Duyne-Panetta legislation, if enacted, would require the agency to make public the data used to determine a provider’s eligibility for the SFP, as well as the algorithm used to make that determination.

“While we’ve made important progress on hospice accountability, more must be done to prevent bad actors in this industry from slipping through the cracks,” said Panetta, in a statement. “I’m proud to work with Rep. Van Duyne on this bipartisan legislation that would strengthen penalties for those who fail to uphold quality care standards and evade the law, while at the same time support reputable hospice providers who deliver dedicated, compassionate care. This action builds off our HOSPICE Act and is important for the oversight and integrity of our hospice care system.” 

The bill would also forbid CMS from placing a hospice into the SFP unless it had undergone a state, local or accreditation agency survey during the most recent 36-month period. 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.

The SFP algorithm has been controversial. Each of the major national hospice industry organizations has voiced concerns about the algorithm, contending that it would not effectively capture poor performing hospices. This included LeadingAge, the National Partnership for Healthcare and Hospice Innovation (NHPI), the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO). NAHC and NHPCO have since combined into the National Alliance for Care at Home.

In August of last year, these organizations sent a joint letter to CMS asking to delay the SFP to allow for the development of a new methodology.

“The soon-to-launch hospice special focus program (SFP), while well-intentioned, is in its current design, flawed,” said Katie Smith Sloan, president and CEO, of LeadingAge, in a statement about the bill. “The Enhancing Hospice Oversight and Transparency Act would ensure transparency to those hospices chosen for the SFP, require completed surveys prior to the SFP’s launch, and delay the launch of the SFP program, all of which are important elements to ensuring the SFP is implemented as intended.”

Later, four members of Congress led by Van Duyne and Rep. Earl Blumenauer (D-Oregon) also called on CMS to delay the program and reconsider their methodology for selecting hospices. Panetta and Brad Wenstrup (R-Ohio) were also signatories on the letter to CMS Administrator Chiquita Brooks-LaSure and White House Office of Management and Budget Director Shalanda Young. The four lawmakers indicated their belief that the SFP, as currently designed, would not adequately identify poor performing hospices in need of the program.

“Conceptually, the creation of the hospice [SFP] is a positive step meant to improve oversight of poor performing hospice providers and guarantee action is taken to address deficiencies in care delivery,” said Tom Koutsoumpas, CEO and founder of NPHI, in a press release. “However, we continue to have serious concerns about the algorithm CMS has finalized to identify the providers who will be eligible for inclusion in the SFP.”

Stakeholders in the hospice space have spoken out in support of the bill.

“Ensuring the highest quality of care for hospice patients is essential. Medicare beneficiaries and their families deserve clear, accurate information to make informed choices,” said Dr. Steve Landers, CEO for the National Alliance for Care at Home, in a statement. “The Alliance supports the Enhancing Hospice Oversight and Transparency Act, a bipartisan initiative to pause the flawed SFP program and enable necessary redesign through collaboration among CMS, Congress, and key stakeholders. Together, we can build an oversight system that ensures quality care, guides families toward high-performing hospices, and holds accountable any providers unwilling or unable to meet these standards.”