Two U.S. Senators have penned a letter to congressional leadership urging them to oppose any measures to bring hospice reimbursement into Medicare Advantage.

Sens. Dr. Roger Marshall (R-Kan.) and Sheldon Whitehouse (D-R.I.) circulated the letter on Thursday, addressed to Senate leaders from both major political parties, as well as the chair and ranking member of the Senate Finance Committee. 

“We write to express our strong, bipartisan support for policies that preserve Medicare’s Hospice Benefit under Original Medicare, including for Medicare Advantage (MA) beneficiaries, which has protected their access to high-quality, timely end-of-life care for nearly three decades,” the senators wrote. “As Congress considers potential reforms to the MA program, we urge you to maintain this critical safeguard and oppose any proposals that would include hospice in the Medicare Advantage program, including repeal or alteration of the Special Rule for Hospice.”

The “Special Rule” was established under the Balanced Budget Act of 1997. It stipulates that Medicare Advantage beneficiaries revert to Medicare Part A when they elect the hospice benefit. These patients may maintain their MA insurance to cover services unrelated to their terminal condition as well as supplemental benefits.

Among the senators’ concerns were potential delays of care due to MA prior authorization processes, as well as reduced patient choice due to network limitation.

“Adding MA plan management on top of this system would be duplicative and inefficient, creating new administrative barriers without improving care,” the senators wrote in the letter.

Congress is currently mulling a bill that would, among other reforms, allow for hospice reimbursement through Medicare Advantage. Rep. David Schweikert (R-Ariz.) in May introduced the Medicare Advantage Reform Act. If enacted, the bill, numbered H.R. 3467, would make wholesale changes to the Medicare Advantage (MA). A key provision of the bill is a proposed requirement that MA plans pay for hospice care.

The National Alliance for Care at Home, LeadingAge and the National Partnership for Healthcare and Hospice Innovation (NPHI) in June sent a joint letter to Schweikert voicing opposition to that portion of the bill. Bringing hospice under Medicare Advantage would undermine patient choice, adversely impact timely access to care and leave providers with lower reimbursement rates, according to NPHI, LeadingAge and the Alliance.

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 demonstration did not result in increased or earlier access to hospice or better care coordination. As a result of these challenges, the hospice component of the demonstration was terminated seven years earlier than originally planned,” they wrote. “This failed demonstration underscores why Congress must continue to preserve the Special Rule and keep the Medicare Hospice Benefit separate from Medicare Advantage.”