November 8, 2019
On November 7, 2019, Senators Rob Portman (R-OH) and Ben Cardin (D-MD) introduced S. 2807, a bipartisan bill entitled the Hospice Care Improvement Act of 2019, specifically written to address the concerns identified by the HHS Office of Inspector General about hospice survey deficiencies and patient harm. NHPCO supports many of the policies in the bill as it closely tracks NHPCO’s recommended Hospice Program Integrity Initiatives. Thank you to the Legislative, Regulatory, and Quality Committees for their work on vetting and approving many of the program integrity measures that were included in this legislation. NHPCO will continue to engage with the sponsors of the legislation and hope to further refine the legislation to include enhanced access to hospice.
OIG Reports and Program Integrity: In July 2019, the HHS Office of the Inspector General (OIG) issued two reports that outlined deficiencies with CMS monitoring of hospice and examples of poor care. The reports attracted a great deal of negative attention from policy makers, were featured on NPR and the NBC nightly news and caused some members of Congress to say that “we have to do something about hospice.” The “do something” could have meant public hearings on hospice, a Congressional investigation or worse, definitely not the publicity that the hospice community would want.
NHPCO staff immediately began dialogue with the relevant Congressional committee staff – on the House side, the House Ways and Means Committee and on the Senate side, the Senate Finance Committee. The “do something” discussion evolved into creating a hospice program integrity bill that would address some of the issues identified for CMS by the OIG. Discussions with both the OIG and CMS identified key areas where legislative action could be helpful in addressing hospice program integrity issues.
Discussions with NHPCO Regulatory, Legislative Affairs and Quality and Standards Committees: Shortly after the OIG reports were published, NHPCO engaged the Regulatory, Legislative Affairs, and Quality and Standards Committees to discuss hospice program integrity issues identified by the OIG. NHPCO staff shared discussions with policymakers, House and Senate committee staff, the OIG and CMS with the three NHPCO committees to continue the dialogue and to identify a series of program integrity initiatives that would address the concerns noted in the OIG reports. Each committee voted on each of the program integrity initiatives and only those who were approved by all three committees were included in the final NHPCO Program Integrity Initiative document. NHPCO staff shared the Program Integrity Initiative document in discussions with legislative champions and the Administration to craft draft legislation that would balance the need for smart, targeted oversight and education without imposing excessive regulatory burden.
Alternative sanctions: Discussions with both OIG and Congress centered around their desire to identify alternative sanctions for hospice, named as an issue by the OIG. Alternative sanctions for hospice are not currently available and must be authorized in statute for CMS to take any action for a hospice provider’s deficiencies, short of decertification. The alternative sanctions listed in the bill mirror those for home health, without the additional civil monetary penalties sanction. The most serious of the alternative sanctions, partial or full suspension of payments for all new admissions, is a very serious alternative sanction and could be used when the survey deficiencies identified have implications for significant patient harm. There is a provision in the bill, however, that gives the Secretary discretion to add other alternative sanctions. The addition of alternative sanctions gives CMS and surveyors options to use in correcting survey deficiencies short of decertification. More detail on the specific alternative sanctions can be found on page 4 of this Alert or on page 3, Section 3 of the bill (S. 2807).
Provisions of the Bill
The Hospice Care Improvement Act of 2019 includes provisions that aim to increase reported hospice data, improve the hospice survey process and increase compliance of quality standards for hospice care. Details about the bill follow.
B. Improving the Hospice Survey Process
C. Annual Report of Deficiencies
3. INCREASING COMPLIANCE OF QUALITY STANDARDS FOR HOSPICE CARE
A. Increasing Payment Reductions for Failing To Report Quality Measures
B. Authority To Impose Alternative Sanctions
NHPCO remains concerned about the title of the bill and would like to see a reference to smart and effective oversight of hospice programs. Another concern is that this legislation does not incorporate the provisions of the Rural Access to Hospice Act (H.R.2594/S.1190) which is an important statutory fix for the barrier Medicare beneficiaries face when they are served by a Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC). NHPCO will continue to advocate for the inclusion of the Rural Access to Hospice Act in any program integrity packages that may be under consideration.
NHPCO looks forward to working with our legislative champions in the Senate to shepherd this bill through the legislative process and will continue to engage with our House champions on a companion bill. NHPCO thanks the many members who reached out, engaged, participated in focus groups, conferred in committees, and contacted their Members of Congress to make this bill a reality. We look forward to continued grassroots engagement and appreciate your ongoing commitment to high-quality, person-centered care for all Americans.
Download the text of the bill, S 2807. At the moment, no grassroots advocacy is needed, but watch for additional communication about this bill in the coming days.
Vice President, Communications