Rep. David Schweikert (R-Ariz.) has introduced the Medicare Advantage Reform Act, which among other provisions would require health plans to pay for hospice care.

If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage program. It would mandate capitated payment models, change risk adjustment methodologies and create new exemptions for physician self-referrals, among other provisions.

The potential impacts of moving hospice into Medicare Advantage at this time would be “devastating,” according to the National Alliance for Care at Home.

“Congressman Schweikert’s bill (HR 3467), while attempting to bring about wide-ranging changes to how Medicare Advantage operates, would also dismantle this vital program by forcing hospice care into Medicare Advantage plans,” an Alliance spokesperson told Hospice News in an email. “The consequences would be devastating … This proposal represents an unprecedented threat to end-of-life care. We implore Congress to reject it immediately.”

Potential consequences of the bill could include delays that could leave patients dying without support, restricted provider networks limiting choice, diluted services undermining the unique interdisciplinary hospice program and financial burdens on families, the Alliance indicated in the statement.

Schweikert introduced the bill on May 15, and the legislation was referred to the Ways and Means Committee of the U.S. House of Representatives. The Congress member’s office did not respond to inquiries from Hospice News.

As of Wednesday the bill text was not yet available online, pending a review by the Government Publishing Office. To date, no companion bill has been introduced in the Senate.

Currently, coverage for MA enrollees transfers to fee-for-service Medicare when they elect the hospice benefit.

This is not the government’s first attempt to work hospice into Medicare Advantage. The highest profile example was the hospice component of the Value-Based Insurance Design model (VBID), which ended Dec. 31, 2024.

The U.S. Centers for Medicare & Medicaid Services (CMS) cited operational challenges related to the hospice component that limited and decreased participation among Medicare Advantage Organizations (MAOs) and impacted “a thorough evaluation” of the demo.

The new bill does not incorporate any lessons learned from the VBID program or from previous Congressional intent, according to Mollie Gurian, vice president of policy and government Affairs for the senior care advocacy group LeadingAge.

“This is a radical change: Congress has made decisions over the course of the benefit’s history that deliberately keep hospice separate from Medicare Advantage,” Gurian told Hospice News in an email. “Doing so ensures hospice remains a managed, holistic benefit outside of MA. Efforts, such as a demonstration program through the Center for Medicare and Medicaid Innovation (CMMI) that tested the coverage of hospice by MA plans was unsuccessful for a variety of reasons, including challenging operational issues between plans, CMS and hospice providers that do not seem to have easy fixes.”

Hospice News will continue to cover the legislation as more information becomes available.