Hospice Leaders Urge DC to Change Hospice Oversight

WASHINGTON—The four national hospice provider organizations—LeadingAge, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI)—the Centers for Medicare & Medicaid Services (CMS) and key Congressional stakeholders with recommended legislative and regulatory changes to strengthen hospice program integrity.

The recent entry of large numbers of newly created hospice organizations in several states has heightened long-standing concerns among hospice leaders (as shared with CMS in November 2022) about the adequacy of Medicare certification, accreditation and enforcement processes. The groups asked Congress and CMS to act expeditiously to ensure that only well-qualified advanced illness care providers are permitted to care for and support beneficiaries and their families at the end of life.

These recommendations are the culmination of a year-long effort by each of these organizations to assess various options for improving program integrity in hospice care. The 34 recommendations are grouped into 11 core issue areas; five key points are listed below:

• Limit enrollment of new providers with a targeted moratorium on new hospices: Use existing CMS moratorium authority to limit enrollment of new hospice providers in counties with troubling rates of explosive licensure and Medicare certification growth.
• Enforce against non-operational hospices by revoking Medicare enrollment and increasing site visits: Investigate Medicare provider numbers that show aberrant gaps in Medicare billing. Revoking enrollment of non-operational hospices prevents them from being sold to inexperienced providers for a profit.
• Develop hospice “red flag” criteria: Identify Medicare certification application “triggers” related to specific areas of concern that would prompt CMS to investigate an applicant before certification could be approved. Red flags should include:
  • Co-location of multiple hospices at single address
  • A single hospice administrator overseeing multiple hospices
  • A patient care manager or other hospice leadership staff serving multiple hospices
  • A hospice company that appears to be hidden behind a shell company
• Require surveyors to confirm ability of hospices to provide all four levels of care: Surveyors must ensure hospices have the ability to provide all four levels of care, including General Inpatient Care (GIP) and respite contracts, as well as provision for continuous home care (CHC) and afterhours care.
• Add hospice administrator and patient care manager qualifications to Medicare hospice Conditions of Participation (CoPs): Add education and/or qualifications to the hospice CoPs for these key personnel, including minimum years of experience or a combination of education and experience.

“Good hospice care, because of its holistic, patient-and family-centered compassionate approach to the dying, is a godsend. Bad care and true fraud in this valuable benefit are intolerable. It’s time to take action. America’s population is aging, and high-quality services are needed now more than ever before. Reform must promote high-quality care, including the right services in the right quantity, and eliminate opportunity for misdeeds. Our goal in collaborating with other hospice provider groups, with Congress, and with CMS, is to ensure necessary change. Yet it is only part of the solution; our work will not be complete until we address the desperate need for a system of long-term services and supports that is responsive to how older adults live and die now,” said Katie Smith Sloan, president and CEO, LeadingAge.

“NAHC believes strongly that improved hospice program integrity will benefit patients, families, providers, and the Medicare program, and that it is an essential element in ensuring quality of care. Historically NAHC has strongly supported meaningful solutions to problems as they have arisen within hospice and other programs. The series of recommendations that we are putting forth in conjunction with other national hospice organizations clearly communicate our continued commitment to designing and supporting effective regulations, processes, and operational standards in hospice. We look forward to working with Congress and the Administration to move these recommendations forward,” said NAHC President William Dombi. 

“Ensuring program integrity is essential to enabling good hospice care. That’s why NHPCO has worked for more than 40 years to engage government officials and other partners to shape policy that supports effective oversight of hospices. These recommendations are the latest such effort and are especially topical given the alarming recent growth of Medicare certified hospices in California, Arizona, Nevada, and Texas which are fraudulent actors. NHPCO and national partner organizations must be proactive in our response and intolerance toward deceptive hospice care that does not live up to the standards of high-quality care we expect from members of our community,” said NHPCO COO and interim CEO, Ben Marcantonio.

“End-of-life care providers have an obligation to support and care for patients and their loved ones with dignity and respect at this most vulnerable time in their lives. Providers who manipulate the Medicare benefit solely to profit at the expense of their patients have no place in the hospice program,” said NPHI CEO Tom Koutsoumpas. “To curb the entry of bad actors into hospice, NPHI is pleased to put forth, in conjunction with our national partners, robust program integrity reform recommendations. We look forward to working with our partner organizations, Congress, and CMS to advance meaningful change that will better protect those receiving hospice care at the end-of-life.”

The full list of recommendations is available on each organizations’ website.