Legislation Introduced to Overhaul Medicare Hospice Benefit

WASHINGTON—Congressman Earl Blumenauer (D-OR), a senior member of the Ways and Means Committee, introduced the Hospice Care Accountability, Reform and Enforcement Act (Hospice CARE Act) in an effort to modernize Medicare’s hospice benefit, which has remained largely unchanged since its inception in 1982. 

The proposal comes amid persistent reports of fraud and abuse within the benefit, despite action from the Centers for Medicare & Medicaid Services (CMS). The Hospice CARE Act legislation results from years of collaboration between stakeholders, lawmakers and industry leaders and seeks to ensure the federal government supports families at the end of life. 

“The United States spends significantly more on health care than other developed nations for worse outcomes,” said Blumenauer. “Nowhere is this more egregious than in the hospice industry. Patients and families deserve better. We need a reset. It is past time for Congress to act to end the fraud, waste and abuse within the hospice benefit and bring it into the 21st century.”

Hospice advocates applauded the effort.

“As a long-standing champion of hospice care, Rep. Blumenauer has consistently demonstrated a commitment to ensuring that hospice services remain accessible, compassionate and of the highest quality for patients and their families,” the National Alliance for Care at Home (the newly merged organization formed by the integration of the National Association for Home Care and Hospice and the National Hospice and Palliative Care Organization) said in a statement. “The Alliance appreciates Rep. Blumenauer’s commitment to involving a diverse group of stakeholders in developing this legislation and will continue to work closely with congressional leaders on the finer points of the proposed bill to ensure that the final legislation supports the needs of patients, families and providers alike.”

“The hospice benefit, while unique, is ripe for change,” said Katie Smith Sloan, president and chief executive officer of LeadingAge, an association of nonprofit aging services providers. “This legislation is a first-of-its-kind opportunity to improve it. Revising a benefit that has not been altered significantly since its creation in 1982 is a formidable undertaking—but a necessary one. Done right, changes will expand the benefit to support the realities of modern-day hospice care and address vulnerabilities that are currently being exploited. There is more work to do, and we look forward to continuing our productive partnership to ensure this bill achieves these goals.”

To protect patients and taxpayers, the Hospice CARE Act would institute several reforms to limit fraud, while incentivizing quality care. If passed, the legislation would:

• Reform the payment structure. The underlying hospice per-diem payment structure—which generally pays hospices for each day of care, regardless of if care is provided on a given day—currently rewards those who exploit the benefit for financial gain. The legislation would revise the payment structure, ensuring that providers are incentivized to deliver high-quality care and meet the current needs of individuals and their families.
• Bolster program integrity. Additional safeguards and oversight would be introduced to prevent fraudulent providers from enrolling in Medicare, especially for new hospices. This would include temporarily preventing new hospices from enrolling in Medicare—with exceptions where additional access to care is needed—increasing survey frequency and increasing ownership transparency.

“The National Partnership for Healthcare and Hospice Innovation (NPHI) is thankful for the work of Congressman Blumenauer, his staff and the Ways and Means Committee staff, who worked with the hospice and advanced illness community to put forward the Hospice Care Accountability, Reform and Enforcement (CARE) Act,” said Tom Koutsoumpas, founder and chief executive officer at NPHI, a membership organization of community-integrated hospice and palliative care providers. “This legislation is an encouraging and unique opportunity to consider reforms that would strengthen the Medicare hospice benefit by ensuring it continues to support patients, families and the nonprofit providers who were the original foundation of hospice care. We look forward to continuing to work closely with Congress and relevant stakeholders on efforts to modernize the hospice benefit and improve care of those at the end of life.”

“The Coalition to Transform Advanced Care (C-TAC) truly appreciates the introduction of the Hospice Care Accountability, Reform and Enforcement (CARE) Act,” said Jon Broyles, chief executive officer of C-TAC, a coalition of person-centered care organizations. “We commend (Rep. Blumenauer) for this important work, for his decades of support for compassionate end-of-life care and for bringing policies to the national stage with bi-partisan support. We have had the privilege to work with the Congressman, his staff, Ways and Means Committee staff and other advocates on this bill. It is an important starting point for ideas that will lead to modernizing the hospice program and improving the lives of people with serious illness and their family caregivers.”