COVID-19 Emergencies to End May 11

President Joe R. Biden informed the United States Congress on Monday, January 30, that he will end the COVID-19 public health emergencies (PHE) on May 11, 2023, three years after the PHE was first announced. Ending the COVID-19 PHE will alter how the virus is treated, downgrading it from a pandemic to an endemic public…

National Hospice Leaders Urge CMS and Congress to Advance Program Integrity in Hospice Care through Effective Oversight

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

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.

Omnibus Budget Legislation: Relevant Provisions Affecting Home Care & 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: Bill Text…

Omnibus Budget Legislation: Relevant Provisions Affecting Home Care

  • GO HERE to see the portions of omnibus budget legislation that impacts home health and 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:

Medicaid Home Care

  • Section 5114 Extends Money Follows the Person demonstration program through 2027 at $450 million per year
  • Section 5115 Extends HCBS spousal impoverishment protections through FY2027
  • Section 5131 Provides funding for transitioning Medicaid from the 6.2% enhanced FMAP (not HCBS specific)
    • Quarter ending 3/31/23 — 6.2%
    • Quarter ending 6/3/23  — 5.0%
    • Quarter ending 9/30/23 — 2.5%
    • Quarter ending 12/31/23 — 1.5%     

VA Health Care

  • Section VA Medical Foster Home
    • Includes “home health services” access as part of the MFH change

Earmarked Appropriations and Guidance

  • $236,000 Androscoggin Home Health and Hospice, Maine—for nurse practitioner fellowship program
  • $1,940,000 Hospice of Connecticut, Branford, CT—for facilities and equipment

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.

Action Alert! Tell Congress Not to Cut the Hospice Cap!

Act now to stop the hospice cap cut! NAHC needs our members to engage with your federal lawmakers to express opposition to a major hospice payment cap cut being included in any end-of-year legislative package that Congress is negotiating. As is often the case with large, year-end spending bills, there are many programs and policies Congress wants…

NAHC to Congress: Invest in the Direct Care Workforce

The National Association for Home Care & Hospice (NAHC) has written to congressional leaders, urging them to include workforce investments and permanent extension of the Medicaid Money Follows the Person Program (MFP) and Spousal Impoverishment Protections in the next legislative package. The direct care workforce supporting older adults and people with disabilities in all settings has…

NAHC to Congress: Stop the PAYGO Sequester Cuts

Learn more about this issue and many others NAHC is engaged with by attending the NAHC Advocacy Town Hall. It’s free to all.  The National Association for Home Care & Hospice has written to congressional leaders to urge them to  prevent the Statutory Pay-As-You-Go Act of 2010 (Statutory PAYGO) sequester from taking effect at the…

Senator Seeks Input on Policy Options Related to Health Care Cybersecurity

In early November, Senator Mark Warner (D-VA), Chair of the U.S. Senate Select Committee on Intelligence and co-creator of the Senate Cybersecurity Caucus, issued a policy options paper outlining current cybersecurity threats facing health care providers and systems and offering for discussion a series of policy solutions to improve cybersecurity across the industry. As part…

Action Alert! Tell Congress Not to Cut the Hospice Cap!

Act now to stop the hospice cap cut! NAHC needs our members to engage with your federal lawmakers to express opposition to a major hospice payment cap cut being included in any end-of-year legislative package that Congress is negotiating. As is often the case with large, year-end spending bills, there are many programs and policies Congress…