Please Take This Brief Heart Failure Care Survey

Happy Heart Month! The American Heart Association (AHA) and the National Association for Home Care and Hospice (NAHC) are working together to bring you new education, resources, and connections to help you better care for your patients with Heart Failure (HF).

With a sharp focus on improving the care of HF patients receiving care in the home, please take 3 minutes to complete this AHA/NAHC survey so that we can best support the care you provide to your clients in their homes.

Your feedback will drive the development of relevant education resources we will make available to you. In advance, thank you.

TAKE THE SURVEY

Long Term and Post-Acute Care Law and Compliance (formerly Long Term Care and the Law)

  • March 1–3, 2023
  • New Orleans, LA
  • REGISTER

Hear Insights on Regulatory Changes, Operation Management, Transactions, and Compliance

Nursing facility, assisted living, and home health audiences won’t want to miss this year’s sessions, which focus on cutting edge issues that are front and center within the post-acute continuum. Registrants can attend these sessions in person and then watch sessions they miss on demand after the program. Attendees also have the opportunity to engage with colleagues during the networking opportunities available during and between sessions!

Explore the full schedule for this exciting and informative meeting, where leading in-house and outside lawyers, compliance officers, consultants, and other advisors for the long term care industry will be presenting on legal, compliance, and operational issues faced by providers.

NAHC members who are not AHLA members save $175 on the entire program at registration. In addition, NAHC’s President Bill Dombi will give a Home Health Legislative and Regulatory Update on March 3. Register and book your hotel by February 7 for early bird discounts. Learn more.  


NAHC’S Bill Dombi will speak on Thursday, March 3 at 9:45 am and 1:45 pm:  

Home Health Legislative and Regulatory Update (HH)

  • The 2023 Medicare home health payment rule updates
  • Nationwide expanded Medicare Home Health Value Based Purchasing Demonstration
  • Hospice quality of care survey and sanction reforms
  • Hospice claims oversight
  • Hospice business practices under review
  • 2024 MedPAC recommendations on home health and hospice reforms
  • Status of home care expansions in Medicare
  • Impact of PHE end on home health and hospice waivers by CMS

Connecting With Caregivers: Understanding Direct Care Workers & Their Needs

  • Thursday, January 26, 2022
  • 1:00 PM – 2:00 PM EDT
  • REGISTER
The shortage of direct care workers is a national crisis—and recruiting and retaining them is a priority for the industry. By 2040, the caregiving workforce needs to increase by 8.2 million jobs to meet projected demand. You can better recruit, train and retain caregivers if you can anticipate their needs. Join us for this RoundTable to learn more from experts in the field and get your questions answered.

Speakers:

  • William Dombi, President, National Association for Homecare & Hospice
  • Brandi Kurtyka, CEO, Missioncare Collective
  • Jeff Salter, CEO, Caring Senior Service
  • Hannah Wolfson, Editor, HomeCare Media

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.

ADMINISTRATION FOR COMMUNITY LIVING (ACL) AGING AND DISABILITY SERVICES PROGRAMS

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.

NAHC and CMA Announce New Hospice Resource for Consumers

Over 1.7 million Medicare beneficiaries receive hospice care1. It is one of many benefits available under Medicare and provided by approximately 5,000 Medicare-certified hospices. Each of these hospices must provide certain services and meet specific requirements. However, each can provide these services in different ways. Navigating the details can be confusing, leading to many questions and misunderstandings. Making the decision to choose hospice care and choosing a hospice provider are two of the most important decisions anyone will make for themselves or a loved one. Finding a hospice that meets the needs of each patient may take some time.

To help beneficiaries sort through the details and learn about the hospice options available under the Medicare Hospice Benefit, the Center for Medicare Advocacy (CMA) and the National Association for Home & Hospice Care (NAHC) jointly developed “Questions to Ask When Choosing a Hospice.” These questions are intended to prompt discussion between beneficiaries and hospices so that patients fully understand coverage under the Medicare Hospice Benefit and how these services are provided by the hospice they are considering.

“With a growing use of hospice care, it is essential that Medicare beneficiaries and their families are well-equipped to understand what it takes to choose the right hospice,” said NAHC President William A. Dombi. “We are proud to have the opportunity to team-up with the Center for Medicare Advocacy to contribute well-focused guidance on hospice care and provider options. There are few health care decisions that one may make that are more important than selecting a qualified hospice provider.”

“As patients face terminal illness, the decision to choose hospice care is complex, and often difficult. We hope this document will help patients and families understand Medicare hospice coverage, the benefit from receiving hospice care, and available provider options. The booklet includes questions and guidance we hope will be valuable in finding care people can rely on as they live with serious illness,” said Judith Stein, Executive Director, Center for Medicare Advocacy. The “Questions to Ask When Choosing a Hospice” document is available on the CMA website and the NAHC website.

1MedPAC Report to the Congress (March 2022): https://www.medpac.gov/wpcontent/uploads/2022/03/Mar22_MedPAC_ReportToCongress_v3_SEC.pdf

Our Response to ProPublica Article Alleging Abuse in Medicare Hospice Benefit

An article on the hospice industry published by ProPublica on November 28 (Endgame: How the Visionary Hospice Movement Became a For-Profit Hustle), 2022, gives readers an inaccurate view of the Medicare hospice benefit, a uniquely person-centered program that brought comfort to 1.7 million Americans and their families in 2020.

The article utilizes a few instances of abuse by bad actors to assert that hospice has lost its way. While we condemn fraudulent or abusive behavior, the vast majority of hospice providers remain true to its historic mission of providing comfort and relief from suffering to individuals at the end of life and support to their loved ones.  This is evidenced by Centers for Medicare & Medicaid Services (CMS) data indicating that 81 percent of families/caregivers utilizing the Medicare benefit give the hospice an overall rating of 9 or 10 (with 10 being the best) and 84 percent would recommend hospice to family and friends.

Where inappropriate activity is occurring in hospice, the National Association for Home Care & Hospice (NAHC), hospices across the country, and other industry stakeholders have urged meaningful action, including our support for increasing the frequency with which hospice providers are reviewed for compliance with important health and safety standards (Medicare’s Hospice Conditions of Participation).  Further, in 2019, NAHC other national hospice organizations helped craft a series of hospice survey reforms that were enacted in the Hospice Act of 2020, which are currently being put in place. We expect these reforms, once fully implemented, to provide additional quality of care safeguards in the hospice benefit.

More recently, NAHC and other national organizations have been deeply concerned about the disproportionate growth in the number of hospices in some states. In November 2022, NAHC and three other national hospice organizations wrote to CMS Administrator Chiquita Brooks-LaSure, urging further investigation of the proliferation of hospices in some states and to suggest targeted moratoria in trouble areas of the United States.

“We must all do our part to ensure that hospice remains a viable choice for terminally ill patients and their loved ones,” said NAHC President William A. Dombi. “Unfortunately, articles of this type may unwittingly discourage use of hospice care, thereby denying terminally ill patients and their families access to vital services that support and comfort them during and in the aftermath of one of life’s most difficult journeys.”

The hospice benefit is popular, well-regarded, and saves taxpayer dollars compared to keeping terminally ill patients in hospitals or other institutional centers of care. NAHC and our members look forward to working with federal and state policymakers to implement solutions to address the isolated problems highlighted by the article without jeopardizing access to the Medicare hospice benefit.

Data Alert: CMS Releases Home Health and Hospice Provider Utilization Data for 2020

The Centers for Medicare & Medicaid Services (CMS) posted the annual update of the Post-Acute Care and Hospice Provider Public Use File (herein known as “PAC PUF”) with data for 2020. The PAC PUF now has data available for years 2013-2020. Following are some useful links to access the data: Medicare Post-Acute Care and Hospice…

Our Veterans Deserve the Highest Quality Hospice

On November 11 the United States honors its veterans with Veterans Day, a national holiday. However, making sure our veterans receive the care and recognition they have earned should involve a lot more than a federal holiday in the second week of November. Those who have made great sacrifices deserve proper care when they come home, particularly if they suffer from debilitating health issues, whether in their senior years or earlier in their lives

Among the common maladies afflicting our veterans are:

  • Post-traumatic stress disorder
  • Depression and other mental health issues
  • Traumatic brain injury
  • Musculoskeletal injuries and pain
  • Infectious disease;
  • Chemical exposure;
  • Noise and vibration exposure/sensitivity.

Tragically, an estimated 18 to 22 American vets commit suicide daily. No American should find that statistic tolerable. Our veterans deserve the highest quality health care and that includes care in the home.

The Veterans Administration’s long-term care services include:

  • 24/7 nursing and medical care;
  • Physical therapy;
  • Help with daily tasks (like bathing, dressing, making meals, and taking medicine);
  • Comfort care and help with managing pain;
  • Support for caregivers who may need skilled help or a break so they can work, travel, or run errands.

Veterans can get this care in many different settings — some run by VA and others run by state or community organizations that the VA inspect and approve.

There are three pieces of important legislation before Congress right now that would benefit millions of Americans, including our veterans. They are:

  • Credit for Caring Act – For anyone caring for an elderly or disabled veteran, this legislation would provide a tax credit of up to $5,000 for expenses such as respite care, home modifications, hiring home care aides and other caregiving professionals to provide care and services, and assistive technology.
  • Choose Home Act – This legislation supports patients, such as our veterans, to leave the hospital and recover at home with a mix of expanded skilled nursing, therapy, personal care, telehealth services and more. In this way, eligible patients can choose to recover at home in a safe home environment with appropriate and sufficient care tailored to meet their individual needs.
  • Better Care Better Jobs Act – This legislation would expand access to home care for our elderly and disabled veterans and all Americans by making a significant investment into the Medicaid Home and Community Based Services Program with the goals of improving access to care in the home and addressing workforce challenges.

We hope you will follow the links above to our Advocacy Center and send a quick and easy message to your elected representatives about supporting these bills. It takes literally seconds and just a few clicks of your time.

Quality care in the home is the best health care and we owe our veterans the very best. Let’s all do our part to make it happen.

CMS Provides HQRP Updates During September Forum

On September 28, 2022, the Centers for Medicare & Medicaid Services (CMS) hosted a Forum on the Hospice Quality Reporting Program (HQRP) which, for the most part, provided a review of information published in the FY2023 Hospice Final Rule and recent public reporting activity.

Of note were comments regarding status of the Hospice Outcomes & Patient Evaluation (HOPE) assessment tool.  CMS continues to seek hospice providers to participate in Beta testing of the HOPE tool, and a detailed recruitment announcement is available on CMS’s Hospice QRP Provider and Stakeholder Engagement webpage. Those interested in participating should email HOPETesting@abtassoc.com.

Beta testing is expected to continue into spring 2023, after which CMS and Abt (the HOPE tool contractor) must conduct in-depth analysis of the testing. Following conclusion of this analysis and any modifications that the HOPE tool might undergo as a result, the HOPE tool must go through rulemaking so that public stakeholders have an opportunity to comment on the tool and CMS’ plans for implementation.

Given the time frame for the work that remains to finalize the tool, it is unclear whether CMS will propose the tool as part of the FY2024 proposed hospice payment rule or whether public consideration would be delayed until the next rulemaking cycle (applicable to FY2025).

A recording of the September Forum will be posted in the near future and will be announced in NAHC Report.

CMS Hospice Quality Reporting Program Forum

On Wednesday, September 28th, the Centers for Medicare & Medicaid Services (CMS) will host a webinar to share updates for the Hospice Quality Reporting Program.

During this webinar, Jermama Keys, HQRP Coordinator at CMS and subject matter experts from Abt Associates will provide information on the following topics:

  • The Fiscal Year (FY) 2023 Hospice Final Rule
  • Recent Public Reporting activity
  • Updates related to HQRP

CMS will also answer questions at the end of the webinar, as time allows.

Webinar Details

Title: CMS September Hospice Quality Reporting Program Forum

Date: Wednesday, September 28, 2022

Time: 1:30 – 2:30 p.m. ET

Registration: https://attendee.gotowebinar.com/register/6692944306731233291

A unique access link will be sent upon registration.

Participation Information

After you register, you will receive a dial-in number and webinar link. You will not be able to share your registration information as it will be unique to you. Please check your spam filter if you do not receive an email confirmation.

Attendees will be able to submit questions in various ways, including:

  • Phone – Enter your audio pin and use the hand-raising icon to enable CMS to unmute your line.
  • Computer Mic and Speakers – Enable your microphone and use the hand-raising icon to enable CMS to unmute your line.
  • Chat – Type your question into the “Questions” box.

For More Information

If you have questions, please email CMSQualityTeam@ketchum.com