As the midterm elections approach, hospices have unfinished business in the halls of Congress.
Providers have identified several high priority pieces of legislation they would like to see passed before this Congress ends in December, according to healthcare leaders attending the National Alliance for Care at Home’s Advocacy Week on Capitol Hill. Most of these are oriented around the common theme of preserving access to home-based care.
“Care at home already has bipartisan support and recognition as a cost-effective, patient-preferred solution,” said Jennifer Sheets, CEO of the Alliance, in a statement. “As demand continues to grow, we are committed to being a strong partner with Congress to help federal policy grow with it.”
A chief policy concern is ending the six-month moratoria on hospice and home health enrollment in Medicare. While the moratoria are actions by the executive branch, legislators can help put pressure on the U.S. Centers for Medicare and Medicaid Services (CMS) to let the temporary ban end as scheduled in November.
CMS has the option to extend the moratoria, something most providers don’t want to see, Ken Albert, CEO of the Maine-based home health and hospice provider Andwell Health Partners, indicated.
“The biggest thing right now that we have to accomplish is to work with the administration on fraud, waste and abuse while not restricting access to hospice care,” Albert told Hospice News. “We still have many pockets of America where we have hospice deserts, and to the extent that the moratorium is imposing barriers to expanding access to hospice services or to mergers and acquisitions that would create access. We have to take a serious look at that, and we have to have those conversations with members of Congress.”
Hospice providers support the federal government’s efforts to root out fraud, but this requires more of a “scalpel” approach rather than a “sledgehammer,” Albert said.
One bill currently before the U.S. Hospice of Representatives, if enacted, would direct CMS to use a finer line when it comes to hospice fraud enforcement. This is the Protecting Seniors and Stopping Fraudsters Act, introduced by Rep. Beth Van Duyne (R-Texas).
The legislation is intended to strengthen Medicare oversight, deter scams, safeguard seniors from fraudulent enrollments, and improve accountability throughout the hospice and home health system, according to a statement emailed to Hospice News.
“That is exactly what we need. [Van Dune’s bill] is much more surgical in their approach and offers some very realistic, practical opportunities to prevent fraud, waste, and abuse,” Albert said.
Providers on the home health side of the equation are also seeking legislative action. On their congressional wish list is the Medicare Home Health Payment Integrity and Protection Act, designed to “stabilize” Medicare payments for those services. Stakeholders are also calling on Congress to pursue legislation that would bolster access to Medicaid Home- and Community-Based Services.
The prospect of passing these bills in this Congress is uncertain as the looming midterm elections consume Washington’s attention. Congress can go in one of two directions following an election. They can go into “hurry up” mode to complete what they can before the session ends, or they can ease off to take pressure off of their “lame duck” colleagues.
The possibility exists that lawmakers could roll some of these bills into an end of the year funding or tax package.
Another priority for the provider community is caregiver support. A bill currently before the House, the Credit for Caring Act, would establish a $5,000 tax credit for those who are caring for seriously or terminally ill loved ones in the home. Rep. Mike Carey (R-Ohio) introduced the bill in March.
About 63 million Americans are responsible for ongoing, often complex care for adults or children with medical conditions or disabilities, according to the National Alliance for Caregiving and AARP. The report also found that family caregivers now make up nearly a quarter of the U.S. adult population — a 45% increase since 2015.
This bill also affects access to care as many patients could not receive care in the home without the assistance of a family caregiver, according to the Alliance.
Lawmakers must prioritize access to care in the home in order to meet the needs and wishes of Americans at the end of life, Tamara Schaeffer, a registered nurse and attorney and the daughter of a patient who received services told Hospice News in Washington.
Schaeffer’s father in his final days initially received poor hospice care from a local health system’s service that limited the support for him and the family, but they ultimately found “great hospice care from a higher quality provider,” she said. She came to Washington to advocate for families like her own.
“The greatest honor of my life was to hold my dad’s hand while he stepped into heaven, and I cannot imagine patients who don’t have that opportunity,” Schaeffer said. “I want my voice to be a powerful one that enables and empowers strong home care and hospice reimbursement, so that patients who do want to go home, like my dad, have the opportunity to do it.”
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