The hospice industry is undergoing a transformative period of rising demand and regulatory changes. Providers of all sizes and types are facing mounting operational challenges and financial strains with limited recourse to voice their collective concerns to legislators.

This is according to Scott Levy, chief government affairs officer at National Alliance for Care at Home (the Alliance). Levy stepped into the role earlier this year after holding a similar position at Amedisys (Nasdaq: AMED). He has been involved in government relations, public policy, advocacy and law for more than 20 years.

Levy recently sat down with Hospice News to discuss the array of regulatory and legislative evolutions on the horizon in hospice care delivery. This year providers are contending with new quality measures, increasing audit activity and program integrity issues alongside evolving regulatory policies taking shape under a new administration.

Can you share your background in hospice and home over the last decade, starting with your most recent role at Amedisys?

I started out in a lower-level government affairs position at Amedisys in August 2015. I was promoted chief government affairs officer in 2023. Prior to that I was their senior president of government affairs. I spent a significant amount of my time in Washington D.C. working hand-in-glove on policy issues with colleagues across the home health and hospice industries.

I am a lawyer and attended law school at Louisiana State University (LSU), then I clerked for a judge for a year. I practiced at a regional firm based in Louisiana. I did some regulatory work before the Public Service Commission at the state’s Department of Health. I did some procurement work before the Office of State Purchasing, as well as legislative lobbying before the Department of Insurance and the Department of Education.

All of those are parts of my legal background, combined with my love of politics that I’ve had since a very young age. I got involved in political campaigns early on, and had pretty unique experiences right out of college and before graduating. This was always a career path I wanted to take, but the form of it coming in home health and hospice was not one I expected.

It’s all culminated into the position I’m now in at the Alliance. Home health and hospice became a part of my career and I’ve been able to advocate for other families to have the experiences that my family has had.

How will your past experiences help inform your future policy and advocacy efforts in the home-based landscape?

I served as a quarterback for Amedisys on any regulatory or legislative changes. I would work with our operators, finance team and clinicians to really understand what was coming out of the [U.S. Centers for Medicare & Medicaid Services (CMS)] and Congress. It was also activating the team from a grassroots perspective when it was time to take action, making sure that leaders were paying attention and providing the right information.

Amedisys had such a large scale, that if they were experiencing certain issues that certainly smaller, more regional providers would be experiencing those on a completely different level. We would use our voice on the Hill so that the agency wasn’t the only place where we were making our policy efforts on proposed regulations.

It was communicating issues back to CMS and policymakers. That’s actually the approach we’re trying to build into the Alliance as far as how we can best help by providing as much real-time data and experience as we can to CMS and into the Hill. It’s using the providers’ experiences to help tell the story about what they need. [It’s also] bringing as much provider perspective and understanding into policy as possible. Operators and clinicians are the people being impacted, and ultimately the patients they’re trying to provide care to.

What are the most pressing legal, regulatory and reimbursement issues facing hospice providers today? What are the changes taking shape to address these issues? What is key for hospices to navigate these challenges?

I think auditing is a huge one. There was an auditing pause during COVID, and there has been this jump to recapture audit time, so to speak. The amount of that has overloaded providers.

Even providers well-staffed in this area struggle to keep up with the demands coming through. Those resources that have to be diverted toward responding to audits are ultimately being diverted away from patient care. So it’s figuring out how we can break through that process with CMS.

If we can do some regulatory relief around audits and some other parts of the regulatory regime that don’t actually impact patient care and clinical experience, then providers can breathe a little bit better because they’re able to spend more time on patient care. They can live a little bit better with the insufficient payment updates over the past four or five years, because the inflationary mechanism that CMS uses doesn’t keep up with what providers experience. They’ll have more resources to allocate.

The transition to the [Hospice Outcomes and Patient Evaluation (HOPE)] tool this year is also probably a change that we need to continue to monitor. It seems like the information flowing out of CMS has not been the best, and that’s a significant change. So it’s making sure that hospices are informed and able to advocate through comments on everything that’s coming down over in regulatory processes. This regulatory burden is being put on providers without any ramp up of meaningful opportunities for comments.

I think that the Alliance will have to have a sort of “refresh” with CMS and the new administration coming in to really raise a lot of these issues and get information to and from the providers. We want to help facilitate and make sure that providers are able to voice their concerns on these extremely pressing matters with members of Congress. We’re all pushing on this to make sure that the hospice benefit is protected for those at the heart of it, the patients, families, caregivers and clinicians. It’s that flow of information to legislators about what they’re experiencing and seeing and having different engagement opportunities to connect with them.

How have you seen the hospice industry evolve in regulatory, legal and public policy terms?

One of the things about hospice is that when we’re able to go do advocacy work (specifically on the Hill), then we see more and more people who have personal stories and exposure to it. That makes it easier to make the personal connections that help us protect what is a very sacred benefit and make sure that at the end of the day, we’re doing right by the patients and families. They have literally given up their right to curative care to exercise this incredible hospice benefit, to be comfortable and surrounded by family at home.

Everything that we’re trying to do from a regulatory or legislative standpoint needs to focus around that high level of quality care for people that all patients deserve.

What are some of the biggest regulatory priorities when it comes to hospice care delivery?

It’s understanding that oversight program integrity is very important. And that’s instilled at the Alliance writ large across the board, from our leadership team to our board members, all the way through to the providers that we work with on a day in, day out basis. We are highly committed to making sure that the benefit is free of those bad actors.

The Alliance wants to partner with CMS as the two legacy organizations have for many, many years on ideas. We are doubling, tripling, quadrupling down to cover many iterations since the merger partnership [between the National Hospice and Palliative Organization and the National Association for Home Care & Hospice]. We’re eager to be involved with this new administration from a regulatory standpoint.

It’s also understanding that the benefit hasn’t really changed a lot since it was established. It’s making sure that any changes that are contemplated are done in a very, very thoughtful way, so that we’re not totally disrupting this benefit that, for the vast majority of the people that experience it, is still an incredibly high-quality manner of care.

One of the other things that I think just kind of blew me away when I was started in hospice and home health was the large amounts of mentions of hospice providers in an obituary. If you do a Google search of any hospice provider, definitely some of the larger ones that have more scale, one of the first things that is going to pop up is an obituary thanking the care team who helped them during the end-of-life process. And that’s because of the connection and the bond that patients and their families establish with their clinicians.

Understanding the bond that’s established between clinicians, caregivers and the families and patients — that’s what we’re making sure we’re doing in the policy context. [It’s] ensuring that it doesn’t impact to the degree that we’re dissuading people from making this really difficult, but beautiful choice as they’re getting to that stage.