Congressional Activity Reflects Strong Interest in Palliative Care

A series of bicameral and bipartisan actions in Congress in recent weeks has signalled strong support for the expansion and strengthening of palliative care in the United States.

As the population ages and more people live longer with greater disability and disease, policymakers are increasingly motivated to build out the palliative care infrastructure so that more patients and families can access these vital services that address the stress and symptoms of serious illness. The COVID-19 pandemic and the suffering it has caused have also spotlighted how the status quo system falls short when it comes to addressing what matters most to very sick patients and families, and have bolstered the interest and argument for more and better palliative care across settings.

Provider Training in Palliative Care Act

On September 29, Senators Jacky Rosen (D-NV) and Lisa Murkowski (R-AK) reintroduced the Provider Training in Palliative Care Act (S.2890), which would make changes to the Health Resources and Services Administration’s (HRSA) National Health Service Corp (NHSC) program to make it easier for participating providers to pursue additional fellowship training in palliative care. The NHSC provides scholarships and loan repayment to healthcare professionals practicing at approved sites located in/or serving Health Professional Shortage Areas (HPSAs) throughout the United States. NAHC is a strong supporter of this bill, recognizing the critical need to bolster the palliative skills of the health care workforce.

“NAHC applauds Senators Rosen and Murkowski for reintroducing the Provider Training in Palliative Care Act. Home-based providers of every kind, including those that deliver high-quality palliative care to people with serious illness, are facing unprecedented workforce challenges,” said Bill Dombi, President of the National Association for Homecare and Hospice. “We need creative solutions to expand training opportunities in the kind of holistic, person-and-family centered services that palliative care can provide. By making it easier for National Health Service Corp providers to pursue palliative care education, the bill would increase access to this much-needed care in some of the country’s most underserved communities.”

On October 5, Senator Jeff Merkley joined Rosen and Murkowski in co-sponsoring the legislation.

Palliative Care and Hospice Education and Training Act

Keeping with the drumbeat around supporting the palliative care frontlines, Senator Tammy Baldwin (D-WI) and Representative Yvette Clarke (D-NY-9) recently wrote to congressional Democratic leaders to request that the massive and still-developing reconciliation package include policies to boost and better prepare the serious illness workforce to meet the demands of the future. In a letter, the policymakers urged leadership to use the Palliative Care and Hospice Education and Training Act (PCHETA) as the foundational legislation for these negotiations.

PCHETA would promote education and research in palliative care and hospice, increase the number of palliative care professionals, and implement an awareness campaign to educate the public on its benefits. Passing PCHETA has long been a NAHC policy priority, and we strongly support the inclusion of the bill, or parts of it, in a broader social spending reconciliation package.

Community-Based Palliative Care Demonstration

In addition to these actions focusing on existing workforce challenges, a group of ten U.S. House members from the powerful Ways & Means committee recently penned a letter to CMS Administrator Chiquita Brooks-LaSure, calling for the agency to launch a community-based palliative care (CBPC) demonstration pilot run out of the Center for Medicare and Medicaid Innovation (CMMI). NAHC and other stakeholders in the hospice and palliative care community have been advocating for such a demonstration, and we are grateful for these House leaders’ efforts to encourage CMS to finally bring it to fruition. The letter cites research showing how CBPC not only improves the quality of life for patients and families, but also can reduce unnecessary and unwanted utilization that drives up costs for people with serious illness. As a matter of process, the members write that CMS could either create a new standalone CBPC model, or build upon the success of the existing Medicare Care Choices Model (MCCM). MCCM has been operating for 5 years, and is testing the quality and cost impacts of allowing hospice patients to receive hospice-like palliative care services without having to give up disease-focused “curative” treatments.

recent MCCM evaluation found that demo has reduced Medicare expenditures by $26 million while maintaining a high-quality of care and increasing the likelihood of participating beneficiaries electing the hospice benefit.

Congressional Activity Reflects Strong Interest in Palliative Care

A series of bicameral and bipartisan actions in Congress in recent weeks has signalled strong support for the expansion and strengthening of palliative care in the United States. As the population ages and more people live longer with greater disability and disease, policymakers are increasingly motivated to build out the palliative care infrastructure so that…

HHS Announces $25.5 Billion in COVID-19 Provider Funding

  • Combined application for American Rescue Plan rural funding and Provider Relief Fund Phase 4 will open on September 29

The Biden Administration announced Friday, September 10, that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.

“Home health and hospice will have an opportunity to tap these new funds,” says NAHC President William A. Dombi. “Our concern is that non-Medicare, non-Medicaid home care is still not included. We have been pushing for their inclusion for months, but have seen no movement on such. These are primarily the home care companies that do home care aide services that are private pay along with VA or Area Agency on Aging  funded.”

“This funding critically helps health care providers who have endured demanding workloads and significant financial strains amidst the pandemic,” said HHS Secretary Xavier Becerra. “The funding will be distributed with an eye towards equity, to ensure providers who serve our most vulnerable communities will receive the support they need.”

Consistent with the requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will be based on providers’ lost revenues and expenditures between July 1, 2020, and March 31, 2021. PRF Phase 4 will reimburse smaller providers—who tend to operate on thin margins and often serve vulnerable or isolated communities—for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers.

 Who Is Eligible To Apply and How Will Payments Be Calculated?

Phase 4 General Distribution: Consistent with the requirements included in the December appropriations bill, PRF Phase 4 payments will be based on providers’ lost revenues and increased expenditures between July 1, 2020 and March 31, 2021. Phase 4 will also include new elements specifically focused on equity, including reimbursing smaller providers for their lost revenues and COVID-19 expenses at a higher rate compared to larger providers, and bonus payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare patient.

  • 75% of the Phase 4 allocation will calculated based on revenue losses and COVID-related expenses.
    • Large providers will receive a minimum payment amount that is based on a percentage of their lost revenues and COVID-related expenses.
    • Medium and small providers will receive a base payment plus a supplement, with small providers receiving the highest supplement, as smaller providers tend to operate on thin margins and often serve vulnerable or isolated communities.
    • HHS will determine the exact amount of the base payments and supplements after analyzing data from all the applications received to ensure we stay within our budget and funds are distributed equitably.
    • No provider will receive a Phase 4 payment that exceeds 100% of their losses and expenses.
    • HHS will continue to use risk mitigation and cost containment measures in Phase 4 to protect program integrity and preserve taxpayer dollars.
  • 25% of the Phase 4 allocation will be put towards bonus payments that are based on the amount and type of services provided to Medicaid, CHIP, and Medicare patients.
    • HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.
    • Providers who serve any patients living in Federal Office of Rural Health Policy-defined rural areas with Medicaid, CHIP, or Medicare coverage, and who otherwise meet the eligibility criteria, will receive a minimum payment.

ARP Rural Distribution: Providers who serve Medicaid, CHIP, and Medicare patients who live in rural communities are eligible for the ARP Rural payments.

  • HHS will make payments to providers based on the amount and type of Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) services provided to rural patients.
    • HHS will price Medicaid and CHIP claims data at Medicare rates, with some limited exceptions for some services provided predominantly in Medicaid and CHIP.
    • Providers who serve any patients living in Federal Office of Rural Health Policy-defined rural areas with Medicaid, CHIP, or Medicare coverage, and who otherwise meet the eligibility criteria, will receive a minimum payment.

Terms and Conditions: To help ensure that these provider funds are used for patient care, PRF recipients will be required to notify the HHS Secretary of any merger with or acquisition of another healthcare provider during their Payment Received Period. Providers who report a merger or acquisition may be more likely to be audited to confirm their funds were used for coronavirus-related costs, consistent with an overall risk-based audit strategy.

PRF Phase 4 will also include bonus payments for providers who serve Medicaid, CHIP, and/or Medicare patients, who tend to be lower income and have greater and more complex medical needs. HRSA will price these bonus payments at the generally higher Medicare rates to ensure equity for those serving low-income children, pregnant women, people with disabilities, and seniors.

Similarly, HRSA will make ARP rural payments to providers based on the amount of Medicaid, CHIP and/or Medicare services they provide to patients who live in rural areas as defined by the HHS Federal Office of Rural Health Policy. As rural providers serve a disproportionate number of Medicaid and CHIP patients who often have disproportionately greater and more complex medical needs, many rural communities have been hit particularly hard by the pandemic. Accordingly, ARP rural payments will also generally be based on Medicare reimbursement rates.

In order to expedite and streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application. HRSA will use existing Medicaid, CHIP and Medicare claims data in calculating payments. The application portal will open on September 29, 2021. To help ensure that these provider relief funds are used for patient care, PRF recipients will be required to notify the HHS Secretary of any merger with, or acquisition of, another health care provider during the period in which they can use the payments. Providers who report a merger or acquisition may be more likely to be audited to confirm their funds were used for coronavirus-related costs, consistent with an overall risk-based audit strategy.

“We know that this funding is critical for health care providers across the country, especially as they confront new coronavirus-related challenges and respond to natural disasters,” said Acting HRSA Administrator Diana Espinosa. “We are committed to distributing this funding as equitably and transparently as possible to help providers respond to and ultimately defeat this pandemic.”

To promote transparency in the PRF program, HHS is also releasing detailed information – PDF (PDF – 175 KB) about the methodology utilized to calculate PRF Phase 3 payments. Providers who believe their PRF Phase 3 payment was not calculated correctly according to this methodology will now have an opportunity to request a reconsideration. Further details on the PRF Phase 3 reconsideration process are forthcoming.

Additionally, in light of the challenges providers across the country are facing due to recent natural disasters and the Delta variant, HHS is announcing today a final 60-day grace period to help providers come into compliance with their PRF Reporting requirements if they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period. While the deadlines to use funds and the Reporting Time Period will not change, HHS will not initiate collection activities or similar enforcement actions for noncompliant providers during this grace period.

For more information about eligibility requirements, the documents and information providers will need to complete their application, and the application process for PRF Phase 4 and ARP Rural payments, visit: https://www.hrsa.gov/provider-relief/future-payments.

HHS Announces $25.5 Billion in COVID-19 Provider Funding

Combined application for American Rescue Plan rural funding and Provider Relief Fund Phase 4 will open on September 29 The Biden Administration announced Friday, September 10, that the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), is making $25.5 billion in new funding available for health care…

HHS Announces Provider Relief Fund Reporting Update

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced on Friday, January 15, that it will be amend the reporting timeline for the Provider Relief Fund Program (PRF) due to the recent passage of the Coronavirus Response and Relief Supplemental Appropriations Act. Consequently, PRF recipients will now be required to submit their reporting requirements on their use of these funds later than previously announced.

Starting today, however, PRF recipients may begin registering for gateway access to the Reporting Portal where they will ultimately submit their information in compliance with the new reporting requirements HHS is issuing.

The PRF Reporting Portal is now open for registration and is available here: https://prfreporting.hrsa.gov/s/

The updated reporting requirements are HERE.

A redline comparing the updated reporting requirements to the November 2020 version is HERE.

Reporting Portal Update & Registration Launch

Beginning last summer, HHS began outlining comprehensive reporting instructions that would apply to recipients of PRF funds that received payments exceeding $10,000 in aggregate. HHS previously planned to open the Reporting Portal based on this previously released information by January 15, 2021, with the first deadline for submissions on February 15, 2021. In late December, however, Congress passed the Coronavirus Response and Relief Supplemental Appropriations Act, which added another $3 billion in funding to the PRF program and included language specific to reporting requirements. HHS has been working to update the PRF reporting requirements to be consistent with this new law. HHS wanted to give recipients ample time to familiarize themselves with the updated reporting requirements well in advance of required submission deadlines.

HHS is encouraging all PRF recipients that have received aggregate PRF payments that exceed $10,000 to establish a reporting account by registering at the newly enabled PRF reporting website.

The reporting requirements released today do not apply to funds from: Nursing Home Infection Control, Rural Health Clinics Testing, and COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration for the Uninsured recipients. While there is currently no deadline for providers to establish a reporting account in the newly enabled Reporting Portal, all providers will be required to complete this first step in order to advance and fulfill their reporting requirements once HHS announces the new deadline to do so. Provider support and call center resources are currently limited but will be more available to answer providers’ questions once the second phase for reporting submissions is announced.

More information about the new reporting requirements and portal registration can be found here.

Latest Payments:

As of the week of January 11, HHS has made the following total payments through both the General and Targeted Distributions of the PRF program:

  • $116,956,445,191 in payments to 644,091 provider TINs.
  • Of these payments, 403,235 providers (unique TINs) have attested to the Terms and Conditions for $101,933,833,186 in payments. A listing of PRF distributions to providers that have accepted the Terms and Conditions can be found here.

As of January 13, 2021, HHS has made COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing and Treatment of the Uninsured payments to 30,074 providers including:

  • Testing claims: $1,455,529,631
  • Treatment claims: $1,557,659,437

A listing of health care entities that have agreed to the Terms and Conditions and received claims reimbursement can be found here.

For more information on the Provider Relief Fund Program, visit hhs.gov/providerrelief.

HHS Announces Provider Relief Fund Reporting Update

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced on Friday, January 15, that it will be amend the reporting timeline for the Provider Relief Fund Program (PRF) due to the recent passage of the Coronavirus Response and Relief Supplemental Appropriations Act. Consequently, PRF recipients will…