Omnibus Budget Legislation: Relevant Provisions Affecting Hospice

The Omnibus bill is massive at over 4100 pages. We have distilled those provisions that directly or indirectly affect home care and hospice. Those include both policy changes and funding actions through federal appropriations. NAHC will continue to keep the community aware of and understanding the implications of this end-of-the-year legislation. Relevant links:

Medicare Overall

  • Postpones the risk of an across-the-board 4% rate cut related to PAYGO requirements applicable to the American Rescue Plan legislation in 2021.
    • PAYGO requires that Congress pay for new spending with spending reductions elsewhere or new revenue offsets
    • “kicks the can down the road” through 2024.
    • While an upcoming risk, most likely that Congress will ultimately waive the PAYGO requirements at some point
  • Section 4163 Extends Medicare sequestration for first 6 months of 2032 and sets sequestration at 2% for 2030 and 2031

Medicare Hospice

  • NO major across-the-board hospice cap cut included in the bill
  • Section 4162 Extension of adjustment to calculation method of updates to annual hospice cap
    • Extends by one year the change to the annual updates to the hospice aggregate cap under the IMPACT ACT of 2014 that applies the hospice payment update percentage rather than the CPI-U through 2032
  • Section 4162  Extension of the IMPACT Act’s hospice aggregate cap methodology adjustment for one additional year through 2032
    • Note: 2014’s IMPACT Act changed how the cap was calculated by updating it annually by the hospice annual payment update [APU] amount set by CMS, instead of an annual measure of medical inflation
  • Section 4113 Two-year hospice specific extension of flexibility to perform face-to-face (F2F) hospice recertification visit via telehealth until Dec 31, 2024
  • Section 4121 Starting Jan 1, 2024 – Allowing hospices to include marriage and family therapists (MFTs) and/or mental health counselors (MHCs) as part of the hospice interdisciplinary team (IDT), in lieu of a social worker
    • It would be the up to the hospice to decide whether to use an MFT or MHC – they are not required to use them, and a hospice would still be required to use a social worker if that is what the patient’s plan of care called for
  • Legislative Appropriations Guidance
    • Evidence review and TEP to inform development of quality standards for grief and bereavement care (led by AHRQ – must include engagement with hospice community)
    • Grief and Bereavement Report – ASPE, in collaboration with CDC, NIH, and the Assistant Secretary for Mental Health and Substance Use, must develop a report on the scope of need for high quality bereavement and grief services no later than 180 days after the omnibus becomes law…Part of this work would focus on the role of hospice programs in supporting community bereavement and grief services.
    • Language encouraging NIH to “intensity national research programs in palliative care”

Skilled Care Workforce.

The agreement urges the Employment and Training Administration (ETA), in collaboration with the Department of Health and Human Services, to support the expansion of the skilled care workforce to care for a rapidly aging U.S. population and provide home and community-based services to older adults and people with disabilities, including through education and training grant programs, as well as traditional and nontraditional apprenticeship programs.

Addressing Workforce Shortages.-

The agreement supports HRSA’s efforts to develop the workforce needed to care for a rapidly aging U.S. population. The agreement encourages HRSA to address the skilled care workforce needs of seniors through existing workforce education and training programs.

Nurse Education, Practice, Quality and Retention (NEPQR)

The agreement includes $59,413,000 for competitive grants within the NEPQR program. Within this total, the agreement provides $10,750,000, an increase of $5,000,000 above the fiscal year 2022 enacted level, to expand competitive grants to enhance nurse education through the expansion of experiential learning opportunities. The grants shall include as an allowable use the purchase of simulation training equipment. HRSA shall prioritize grantees with a demonstrated commitment to training rural health professionals in States with high rates of chronic age-related illness, including stroke, heart disease, and chronic obstructive pulmonary disease.


Protection of Vulnerable Older Americans.-

Within the total, the agreement includes an increase of $2,000,000 for the long-term care ombudsman program.

National Family Caregiver Strategy.-

The agreement continues to provide $400,000 for the Family Caregiving Advisory Council.

Aging Network Support Activities.-

The agreement includes $5,500,000 for the Care Corps grant program , with an increase of $1,500,000 for subgrants to programs that are capable of building a network of screened and trained volunteer chaperones to accompany older adults and adults with disabilities in need to and from non-emergency medical appointments and outpatient procedures.

The agreement includes $2,000,000 for a direct care workforce demonstration project to identify and reduce barriers to entry for a diverse and high-quality direct care workforce, and to explore new strategies for the recruitment, retention, and advancement opportunities needed to attract or retain direct car e workers.