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…
The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service claims. As a result of this Act, a suspension on the sequestration was put in place due to the COVID-19 public health emergency (PHE.) The sequestration was suspended through March 31, 2022.
Effective April 1, 2022, the one percent sequestration payment adjustment will be applied for claims with dates of services from April 1, 2022 to June 30, 2022.
Of note, the sequestration payment adjustment will revert to the two percent rate for claims with dates of services as of July 1, 2022. This will bring the total sequestration rate to two percent, which was the rate in effect prior to the PHE.
For home health providers, the adjustment applies to the respective “through” date on the claim.
The sequestration payment adjustment decrease will appear on the RA with a CARC 253, used to report the sequestration reduction. The code will appear as a CO 253 on the RA “Sequestration – reduction in federal payment” as the reason.
The Protecting Medicare and American Farmers from Sequester Cuts Act impacts payments for all Medicare fee-for-service claims. As a result of this Act, a suspension on the sequestration was put in place due to the COVID-19 public health emergency (PHE.) The sequestration was suspended through March 31, 2022. Effective April 1, 2022, the one percent sequestration…
- Boosts HHS Funding & Extends Sequestration to 2023
On Monday, March 28th, President Biden released a $5.8 trillion proposed budget for fiscal year (FY) 2023, which begins October 1st, 2022. While the White House budget is simply a request and Congress has final say on government spending, it does provide a window into the president’s priorities and where his administration wants to direct its efforts going forward. As a reminder, lawmakers just this month finalized spending for the current fiscal year — which runs through Sept. 30 — and will soon begin negotiating funding legislation for FY2023.
The budget requests more than $127 billion to fund the Department of Health and Human Services (HHS) in FY2023, a roughly 15 percent spike from 2022 funding that includes major increases for pandemic preparedness and public health surveillance. Notably, the budget also would extend the Medicare sequester cuts by one year until 2032 (they were previously extended through 2031 by The Infrastructure Investment and Jobs Act of 2021), which would provide savings of around $7.6 billion.
Over the coming weeks members of the Executive Branch will be testifying before key committees in the House and Senate to provide additional detail around the recommendations put forth in the budget documents. As additional relevant detail is made available, it will be covered in NAHC Report.
Provisions of interest in the Budget include:
Multiple provider types:
- Extension of the Medicare sequestration provider rate cuts through 2032 (they are currently in place through 2031)
- Standardize Data Collection to Improve Quality and Promote Equitable Care: Current law requires post-acute providers (inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies) to report standardized patient assessment data on five health assessment categories, as well as “other categories deemed necessary and appropriate by the Secretary.” However, there is no express statutory requirement for data reporting on social determinants of health. This proposal would add a new category of standardized patient assessment data, “drivers of health”, for post-acute care providers. These data could include, for example, transportation, housing, social isolation, and food insecurity. This new data would enable real-time information exchange between the healthcare system and those resources best equipped to address individual needs—activating government, community agencies, and healthcare providers to work together to support individuals of underserved populations and be responsive to respond to public health needs.
Health Care Workforce
- Requests a total of $2.1 billion for numerous Health Resources and Services Administration (HRSA) workforce programs—including $430 million in mandatory and other sources of funding—an increase of $324 million above FY 2022 enacted, including additional investment to support the resiliency, mental health, and well-being of health care providers.
Program Integrity and Oversight Efforts:
- Requests $899 million in discretionary funding for the Health Care Fraud and Abuse Control (HCFAC) program, $26 million above the FY 2022 enacted level ($692.2 million for CMS; $109.6 million for the HHS OIG; $97.2 million for DOJ) (this would be on top of the $1.4 billion in mandatory HCFAC resources for FY 2023)
- Mentions that CMS would use some of this money to invest in new advancements in predictive modeling and artificial intelligence to enhance existing efforts to reduce improper payments, prevent fraud, and target bad actors, while limiting burden. For example, CMS is exploring methods of using machine learning to conduct more rapid review of chart documentation to improve payment accuracy.
- Mentions that a top priority for this increased investment is Medicare medical review, and that CMS has a long-term goal to increase the percentage of fee-for-service claims subject to medical review, which currently stands at less than one-tenth of one percent, to one percent.
- Prohibit Unsolicited Medicare Beneficiary Contacts: Since the start of the COVID-19 pandemic, Medicare scams have proliferated that utilize unsolicited contacts with Medicare beneficiaries for the purpose of ordering or rendering high-cost items and services, such as medically unnecessary laboratory testing and COVID-19 personal protective equipment, as well as to collect beneficiaries’ personal information. This proposal would disallow certain ordering or referring providers, home health agencies, laboratories, other providers and suppliers as identified by the Secretary, and other individuals or entities acting on behalf of such providers and suppliers from making certain unsolicited contacts with Medicare beneficiaries. Prohibited contacts would include phone calls, text messages, direct messaging applications, and e-mail. The proposal would also grant the Secretary authority to announce rulemaking to modify the parameters restricting unsolicited provider contacts with beneficiaries to address emerging fraud threats CMS identifies in the future.
- Expand Tools to Identify and Investigate Fraud in the Medicare Advantage Program: This proposal would require Medicare Advantage plans to collect referring provider identifiers for healthcare services and report this information as part of encounter data submissions to CMS. By requiring Medicare Advantage Organizations to collect key provider data to assist with investigations, this proposal would provide CMS and the HHS-OIG with improved capabilities to hold wrongdoers accountable. CMS would have improved capabilities to prevent program losses and beneficiary harm. Medicare Advantage Organizations would benefit from more actionable data in their own systems and the Federal Government’s broader visibility into fraud affecting multiple plans. This proposal would not require additional funding.
- Improving Equity in Medicare and Medicaid Programs: Requests $35 million for CMS to invest in a new initiative to systematically identify and resolve barriers to equity in each CMS program through research, data collection and analysis, stakeholder engagement, building upon rural health equity efforts, and technical assistance.
- Increase Social Security Administration Sharing and Collection of Race and Ethnicity Data for Medicare Beneficiaries: The primary source of race and ethnicity data on Medicare beneficiaries has been the Social Security Administration (SSA). Currently, SSA collects limited race and ethnicity data on some Medicare beneficiaries and does not collect any data on other beneficiaries, which hinders CMS’s ability to identify and reduce health disparities. The current collection of race and ethnicity data complies with certain 1997 OMB guidelines but does not comply with the more expansive 2011 HHS Data Standards that, for example, provide more detail on the diversity of Asian populations in the United States, such as Chinese, Vietnamese, and Filipino. This administrative proposal would have SSA increase sharing of race and ethnicity data with CMS for current and prospective Medicare beneficiaries, and consider expanding collection of detailed data, e.g., at 2011 HHS data standards or newer data standards. CMS will assist by conducting appropriate research and user testing for collection of this data to ensure it is useful for the purposes of tracking disparities in healthcare treatment and outcomes by race and ethnicity.
Surveys and Certifications (Medicare & Medicaid)
- Requests $494 million for Survey and Certification, an increase of $97 million or 24 percent above FY 2022 enacted. This investment will strengthen health, quality, and safety oversight for approximately 67,000 participating Medicare or Medicaid provider facilities. Survey workloads and costs continue to increase due to factors such as a growing number of beneficiaries and surveyor wage growth, as well as an increase in serious complaints against facilities, which can lead to costly ongoing enforcement activities once a deficiency is identified. The COVID-19 pandemic has underscored the Survey and Certification program’s critical oversight role for holding nursing homes and other facilities accountable to meet minimum infection control standards and protect public health for beneficiaries in these facilities from COVID-19.
- At the FY 2023 request level, CMS projects that states will have the resources to fully complete surveys for all provider types, including complaint surveys, statutorily required surveys, and non-statutory surveys. This level of survey completion, which has not been projected since the submission of the FY 2017 President’s Budget, would permit the program to provide oversight for the relevant facility types and is the first step in shifting from a reactive to proactive posture.
Department of Labor (DoL)
- Priorities for DoL Rulemaking: In FY 2023, the Occupational Safety & Health Administration (OSHA) is planning to publish five final rules, seven proposed rules, and complete one Small Business Regulatory Enforcement Fairness Act panel. The highest priorities among the rulemaking projects on the agency’s regulatory agenda include Infectious Disease, Workplace Violence, Hazard Communications, Personal Protective Equipment (PPE) Fit, and Heat Illness Prevention.
- Increased Funding for OSHA Inspections and Staff: An increased funding request of $27,876,000 to strengthen OSHA’s enforcement program. This includes funding to hire 179 Compliance Safety and Health Officers (CSHOs) to carry out front line compliance inspections. OSHA also plans to create 10 specialized technical CSHO positions to address highly technical inspections across the nation, such as process safety management, electrical safety, ergonomic hazards, combustible dust, and biohazards/infectious diseases, such as COVID-19. The Administration has previously stated its commitment to double the number of OSHA inspectors by the end of President Biden’s first term.
- Increased funding for DoL’s Wage and Hour Division (WHD) Enforcement: A $61 million increase for WHD’s budget to combat worker misclassification, protect essential workers by safeguarding their pay and recovering back wages, and more fully enforce rules around other areas such as prevailing wages and family and medical leave.
Health Information Technology
- The budget directs $52 million at the program level for the Office of the National Coordinator for Health Information Technology (ONC) towards improving standards to increase interoperability and equity among various health IT activities, in coordination with industry-led standards development organizations, as well as using the resources for fulfilling unmet legislative requirements.
- Improve CMS Analytic Capabilities and Data Sharing: As the largest payer for healthcare in the United States, CMS holds an enormous amount of unique health data on a large proportion of the U.S. population. The budget invests $15 million in a new initiative to improve the accessibility, timeliness, and comprehensiveness of CMS data made available to stakeholders and the public. This increase in funding will lead to greater analytic and data sharing capabilities while also continuing to safeguard individual privacy. Better, more timely use of these datasets holds the potential to strengthen the evaluation of federal and state programs, assess the impact of policy changes, improve outcomes of people served by multiple programs, and generate knowledge to inform federal and state policymaking.
- Enhancing HIPAA Protections by Increasing Civil Monetary Penalty Caps and Authorizing Injunctive Relief: The proposal seeks to increase the amount of civil money penalties that can be imposed in a calendar year for HIPAA non-compliance and authorizes OCR to work with the U.S. Department of Justice to seek injunctive relief in federal court for HIPAA violations.
Administration for Community Living (Funding for aging and disability community-based-organizations)
- Provides $3.1 billion for ACL, an increase of $668 million above FY 2022 enacted. The budget recognizes the significantly increased demand for critical services caused by growing populations and the long-term effects of the COVID-19 pandemic.
- In FY 2023, the budget provides $266 million, an increase of $61 million above FY 2022 enacted, for the Family Caregivers and Native American Caregiver Support programs, and nearly doubles funding, from $8 million to $14 million, for the Lifespan Respite Care program. These programs provide more than 1.5 million caregivers counseling, training, respite care, and other coordinated services to allow them to support their loved ones while maintaining their own health and well-being.
Mental Health Care
- Improve access to Medicare mental health services by allowing Licensed Professional Counselors and Marriage and Family Therapists to directly bill Medicare for their services; removing limits on the scope of services for which Clinical Social Workers, Licensed Professional Counselors, and Marriage and Family Therapists can be paid by Medicare; allow these practitioners to bill Medicare directly for their mental health services for covered Part A qualifying Skilled Nursing Facility stays; establish Medicare payment under Part B for services provided under an Assertive Community Treatment delivery system; allow payment to Rural Health Clinics and Federally Qualified Health Centers for Licensed Professional Counselors and Marriage and Family Therapists providing mental health services; and enable Medicare coverage of evidence-based digital applications and platforms that facilitate the delivery of mental health services.
Community Health Workers:
- Add Medicare Coverage of Services Furnished by Community Health Workers: Under current law, services provided by community health workers are not paid under Medicare. This proposal would provide coverage and reimbursement to community health workers acting within the scope of their license or certification under Medicare’s Physician Fee Schedule for select, evidence-based preventive, chronic, and behavioral care management services, as well as certain social determinants of health evaluation and navigation services, effective CY 2024. Such services would be exempt from Medicare cost-sharing. Services must be furnished under the direction of—and billed by—a Medicare-enrolled supplier or provider in accordance with a comprehensive community needs assessment and engagement plan. In addition to existing Medicare providers, the Secretary would be permitted to enroll community-based organizations (e.g., non-profits, public health departments, etc.) as community health worker suppliers to broaden access to services, subject to program integrity and patient safety guardrails.
Agency for Healthcare Research and Quality (AHRQ)
- All-Payer Claims Database: Provides $5 million to develop the infrastructure to regularly create and disseminate an All-Payers Claims Database. AHRQ will partner with states and other data holders to create a framework for a secure claims database that will enhance value to individual participating states and provide analytics to federal policy makers to inform decision making, address equity issues, and improve healthcare quality.
- Telehealth Centers for Excellence: The establishment of two Centers of Excellence in Telehealth Implementation. These centers will play a role in evaluating the effects of telehealth on healthcare delivery and health outcomes to ensure the promise of telehealth is delivered through evidence-based practice and policy. This work is especially important given the rapid expansion of telehealth during the COVID-19 pandemic, which created both historic opportunities and unique challenges. With this unprecedented rapid expansion of telehealth, it is important to understand telehealth’s effect on key health policy priorities and thoroughly evaluate the effect of the telehealth on healthcare quality, safety, equity, access, utilization, and value.
Boosts HHS Funding & Extends Sequestration to 2023 On Monday, March 28th, President Biden released a $5.8 trillion proposed budget for fiscal year (FY) 2023, which begins October 1st, 2022. While the White House budget is simply a request and Congress has final say on government spending, it does provide a window into the president’s…
Late in the evening on Tuesday, March 8, the House of Representatives’ Appropriations Committee released the text of the FY2022 Omnibus government spending legislation. The situation is very fluid right now and the details of the bill could change. For example, after a dispute among lawmakers, $15 billion in Covid-19 relief funding was pulled out of the $1.5 trillion omnibus package leaving the federal government with only a few months’ supply of coronavirus therapeutics.
It is possible the text of the bill could change, but as of Wednesday afternoon, this is what is in the legislation that matters for hospice.
Importantly, the funding package does not include any relief from impending Medicare sequester payment cuts. As a reminder, a one percent across-the-board reduction in Medicare payments is set to take effect April 1, 2022, lasting through June 30, 2022. The full two percent cuts will begin July 2022, lasting through the end of the calendar year. NAHC continues to advocate strongly for a further delay of the sequester reductions. Even as the pandemic enters a more stable phase, the current labor crisis in health care has increased costs for providers of all kinds, and a Medicare rate cut will only exacerbate the already dire workforce situation.
“We are very pleased to see the extension of the telehealth waivers in the bill as they have proven extremely valuable during the pandemic,” said NAHC President William A. Dombi. “Our hope is to see these become permanent parts of Medicare in the future. Also, we anticipate further legislative opportunities this year to deal with sequestration as well as our Choose Home bill among other crucial matters.”
A summary of the Labor-Health and Human Services portion of the bill (where most of the health care provisions are included) is HERE.
Included in the massive bill are a number of provisions relevant to home-based care providers, including:
Telehealth (Sec. 301-309)
- An extension of the Medicare flexibility allowing hospices to perform the face-to-face (F2F) recertification visit via telehealth (Sec. 306). This flexibility will be extended for 5 months (151 days) after the end of the COVID-19 public health emergency (PHE). The current PHE declaration is in place until April 16, 2022, but it may be extended further till at least the middle of July 2022.
- The inclusion of this specific extension is an advocacy win for NAHC and the hospice community. In recent days, intel from Capitol Hill indicated that the F2F fix was not being considered for extension. NAHC, our members, and other hospice stakeholders ramped up our advocacy to Congress to press for the F2F’s inclusion, and we are pleased to see it in the omnibus. We will continue to fight for a permanent extension.
- Like the F2F telehealth extension, many other pandemic-era telehealth flexibilities are being extended for the same 5-months post-PHE timeframe. This includes the changes to the geographic and originating site requirements (Sec. 301), which are allowing patients to receive telehealth services in their own homes and in non-rural parts of the country. It also includes the flexibility to use audio-only telehealth (Sec. 305) It is through this provision that authorization for using telehealth to conduct the home health face-to-face results.
- There is also a provision that will require both a MedPAC and an HHS OIG report on the expansion of telehealth as a result of the PHE, to inform future payment and program integrity policy (Sec. 308)
- Additionally, beginning July 1, 2022, CMS will be required to publicly post, on a quarterly basis, data on Medicare claims for telemedicine services, including data on utilization and beneficiary characteristics (Sec. 308).
- It is important to note that this legislation does not cover extensions for every single Medicare service that has been allowed to be delivered via telehealth during the pandemic. For example, the current flexibility provided hospices to deliver routine home care (RHC) using telehealth and telephone technology would not be extended by this bill. Likewise, a number of specific interventions that have been added to the Medicare Telehealth Code List only for the duration of the PHE would also not be extended by the omnibus. This includes certain Medicare Part B services that have been used by palliative care providers during the pandemic, such as CPT codes 99341-99345, which are evaluation and management (E&M) codes for home visits to new patients. (The current list of Medicare Telehealth Codes can be found HERE). NAHC believes that it will be up to CMS to determine extension policy for those telehealth services not covered by these legislative expansions.
Hospice Cap Methodology Extension (Sec. 312)
- Included is an extension by one year, until 2031, of the current methodology used to update the Medicare hospice aggregate cap by the annual hospice payment update (APU), as opposed to the Consumer Price Index for Urban areas (CPI-U). This methodology of using the APU to update the cap has been in place since 2016 (as a result of the IMPACT Act of 2014) and was already set to remain effective until 2030 (as a result of the Consolidated Appropriations Act, 2021). The provision in this omnibus package simply extends this methodology to 2031. A one-year extension is expected to save the government ~$55-60 million dollars, so when applied across the nearly 5000 Medicare-certified hospices, this provision does not represent a major impact for providers.
CMS Report on Hospice Respite Care (Included in the Joint Explanatory Statement)
- A congressional request to CMS, in consultation with the Office of the Assistant Secretary for Planning and Evaluation (ASPE), to provide, within 180 days of the enactment of the omnibus bill, a report to the relevant congressional committees on the current capacity and best practices for the provision of hospice respite care, including in the home.
Other important elements of the bill include:
- Health workforce: $1.3 billion, an increase of $72 million above the FY 2021 enacted level, for the Health Resources and Services Administration’s (HRSA) Bureau of Health Professions programs to support health workforce development.
- Program integrity funding: Roughly $659 million for CMS’ program integrity efforts; $102 million for HHS OIG program integrity activity; and $112 million for Department of Justice program integrity work within the health care industry.
Additional summary and explanatory documents related to the bill can be found on the House Appropriation Committee’s press release page HERE.
In addition to the omnibus funding package, the House of Representatives also released a very short-term “continuing resolution” bill that will fund the government for four additional days beyond the current funding expiration date of Friday, March 11, 2022. These four extra days will give the Senate time to review and pass the funding package by the new deadline of Tuesday, March 15, 2022.
Text of the bill is HERE. A summary of the entire bill is HERE Late in the evening on Tuesday, March 8, the House of Representatives’ Appropriations Committee released the text of the FY2022 Omnibus government spending legislation. The situation is very fluid right now and the details of the bill could change. For example,…
The National Association for Home Care & Hospice (NAHC), joined by a group of likeminded organizations, has written to congressional leaders to urge them to extend the current two percent Medicare sequester moratorium for the duration of the COVID-19 PHE, and to take action before April 1 when sequestration is scheduled to resume.
NAHC appreciates the bipartisan enactment of The Protecting Medicare and American Farmers from Sequester Cuts Act in December 2021, which extended the suspension of Medicare sequestration cuts, pursuant to The Coronavirus Aid, Relief, and Economic Security (CARES) Act. Suppressing sequestration has provided critical relief in our ongoing battle against COVID-19 and its variants, including Omicron, and enabled health care providers across the country to continue serving their patients and communities. We believe it is time for Congress to revisit the extension’s prescribed structure under which sequestration payment reductions will soon resume, and instead extend the full two percent Medicare sequester moratorium for the duration of the COVID-19 Public Health Emergency (PHE).
Since the beginning of the COVID-19 pandemic, Congress has ensured that frontline health care providers have the resources necessary to keep our doors open to care for both COVID and non-COVID patients alike. While we are encouraged that the worst days of the Omicron variant are hopefully behind us, it is also abundantly clear that daily COVID infection rates, hospitalizations, and deaths remain exceedingly high. Though we strive towards learning to live with COVID in an endemic state, it is likely premature to declare victory over the pandemic.
On February 18, President Biden renewed the COVID-19 National Emergency declaration beyond March 1, 2022, writing that “more than 900,000 people in this Nation have perished from the disease, and it is essential to continue to combat and respond to COVID-19 with the full capacity and capability of the Federal Government.” Along those lines, the U.S. Department of Health and Human Services (HHS) has recently indicated that the COVID-19 PHE will likely be renewed for an additional 90 days beyond the current expiration date in April 2022.
The Protecting Medicare and American Farmers from Sequester Cuts Act authorized a three-month delay of two percent Medicare sequester payment reductions (January 1, 2022 – March 31, 2022), followed by a three-month, one percent reduction in Medicare sequester payment reductions (April 1, 2022 – June 30, 2022). The resumption of the Medicare sequester before the end of the PHE would unnecessarily hinder our caregiving abilities, especially when the emergence of a new, potentially more dangerous and/or contagious variant continues to loom.
Consequently, NAHC believes it is vitally important to extend the current two percent Medicare sequester moratorium for the duration of the COVID-19 PHE, and to take action before April 1 when sequestration is scheduled to resume.
Full list of organizations signing the letter:
- National Association for Home Care & Hospice
- Ambulatory Surgery Center Association
- American Academy of Dermatology Association
- American Academy of Family Physicians
- American Academy of Ophthalmology
- American Academy of Physical Medicine & Rehabilitation
- American Association for Homecare
- American Association of Nurse Anesthesiology
- American Association of Orthopaedic Surgeons
- American College of Allergy, Asthma & Immunology
- American College of Gastroenterology
- American College of Osteopathic Family Physicians
- American College of Radiology
- American College of Surgeons
- American Medical Association
- American Medical Group Association
- American Nurses Association
- American Optometric Association
- American Physical Therapy Association
- American Society for Radiation Oncology
- American Society of Anesthesiologists
- American Speech-Language-Hearing Association
- America’s Essential Hospitals
- Association of American Medical Colleges
- Better Medicare Alliance
- Blue Cross Blue Shield Association
- Brain Injury Association of America
- Federation of American Hospitals
- Healthcare Leadership Council
- Medical Group Management Association
- National Association for the Support of Long Term Care
- Outpatient Ophthalmic Surgery Society
- Premier healthcare alliance
- Private Practice Section of the American Physical Therapy Association
- Vizient, Inc.
The National Association for Home Care & Hospice (NAHC), joined by a group of likeminded organizations, has written to congressional leaders to urge them to extend the current two percent Medicare sequester moratorium for the duration of the COVID-19 PHE, and to take action before April 1 when sequestration is scheduled to resume. NAHC appreciates the…
The National Association for Home Care & Hospice (NAHC) has written a letter to Congressional leaders urging them to work to enact legislative proposals that will prevent billions of dollars in harmful sequestration-related Medicare rate cuts, as well as extend a key PHE-related hospice telehealth flexibility.
Online advocacy outreach campaigns have also been set up so that stakeholders can reach out directly to their congressional delegations and echo these requests to stop the looming cuts and ensure hospices can continue to perform the face-to-face recertification via telehealth after the public health emergency ends.
The letter, which was sent to Senate Majority Leader Chuck Schumer (D-NY), Senate Minority Leader Mitch McConnell (R-KY), Speaker of the House Nancy Pelosi (D-CA), and House Minority Leader Kevin McCarthy (R-CA), asks Congress to take steps soon to delay or avert scheduled cuts to Medicare that are set to take effect starting April 1, 2022. Absent congressional action, a three-month, one percent reduction in Medicare sequester payment reductions will be in place from April 1, 2022 – June 30, 2022, and the full two percent cuts will be in place from July 1, 2022 through the end of the year.
Joining NAHC on the letter are other major national associations representing hospices.
America’s front line health care providers continue to struggle through the COVID-19 pandemic, as well as a historically challenging workforce shortage, both of which have placed unprecedented stress on the entire health care system. Home health and hospice providers are working tirelessly to deliver the best care for patients, families and communities, despite battling major operational pressures. Ongoing financial challenges for home care providers include higher expenses for labor and supplies, lost revenues due to forgone routine visits, and increased emergency costs associated with new COVID-19 surges, among others. Allowing the scheduled Medicare cuts to take effect in April would reduce access to high-quality home-based medical and social services for those individuals and families who have never needed them more.
The letter also requests that Congress, as part of any broader legislative effort to expand COVID-related Medicare telehealth flexibilities beyond the end of the PHE, make sure to explicitly extend the waiver that is allowing hospices to perform the face-to-face (F2F) eligibility recertification via telehealth. Our hospice members have reported that being able to perform the F2F virtually has been a major success and should be permanently, or at least temporarily, expanded beyond the pandemic. Hospices are able to collect all necessary clinical information for recertification, follow patient and family wishes for fewer visits during the pandemic, and allocate staff more effectively due to this flexibility.
However, unlike many of the other pandemic telehealth flexibilities that are authorized in a blanket fashion under HHS’ expanded Section 1135 waiver authority, the hospice recertification flexibility is a separate, standalone statutory provision. Any future broad-based legislative extension of telehealth flexibilities implemented under the 1135 waiver authority would not address the hospice telehealth recertification allowance, so separate legislative action is required for this particular flexibility to be continued post-PHE.
Importantly, a number of popular bipartisan and bicameral bills do call for a permanent extension of the hospice F2F telehealth flexibility, including the Connect for Health Act of 2021 (S.1512/H.R. 2903), the Telehealth Modernization Act (S. 378/H.R. 1332), and the CURES 2.0 Act (H.R. 6000).
NAHC will continue to advocate for inclusion of important home-based care provisions in any forthcoming major legislative vehicles, including the omnibus government funding package currently being negotiated on Capitol Hill.