Physicians Practicing with an MBBS Degree

The National Association for Home Care & Hospice (NAHC) has increasingly been receiving questions regarding whether a practitioner with an MBBS credential is permitted to certify and order services for home health patients. It was noted that many of these practitioners have an enrollment record in the Provider Enrollment, Chain, and Ownership System (PECOS). NAHC…

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):

CMS Proposes Modifications to Requirements for Electronic Prescribing of Controlled Substances

We want to know what you think! Please submit any comments on this to Theresa Forster of the NAHC staff at As part of the calendar year (CY) 2022 physician payment rule, the Centers for Medicare & Medicaid Services (CMS) promulgated significant regulations implementing Section 2003 of the Substance Use-Disorder Prevention That Promotes Opioid Recovery…

FY2023 Hospice Medicare and Medicaid Base Rates at a Glance

–Hospice Medicare FY2023 Pricer Now Available Beginning October 1, 2022, hospice base payment rates will increase by 3.8 percent, as published in the final FY2023 Hospice Payment Rule. As is customary, the Medicaid program waits until Medicare rates are finalized to issue guidance on the applicable corresponding hospice payment rates. The Centers for Medicare &…

CMS Project Targets Providers for Deactivation

NAHC has recently become aware of a project the Centers for Medicare & Medicaid Services (CMS) has initiated that could have an especially negative impact on home health agencies that are not serving Medicare beneficiaries but are required to be Medicare-certified to meet state or non-Medicare payer requirements.  The project is titled “Organization Deactivation Project…

Choose Home Care Act Picks Up Support in Congress

  • Click Here to Urge Congress to support the Choose Home Care Act!

The Choose Home Care Act continues to build support in Congress with the recent addition of new cosponsors in the House of Representatives, including Reps. Sheila Cherfilus-McCormick (D-FL-20), Brian Fitzpatrick (R-PA-1), Al Lawson, Jr. (D-FL-5), and Angie Craig (D-MN-2).

We thank the new sponsors of this legislation for their leadership on this issue.

The Choose Home Care Act seeks to provide an option to patients in where they receive their post-acute care upon discharge from a hospital within the Medicare program. If deemed a good fit by the hospital and home health agency for the Choose Home model, a patient could elect to continue their recovery at home with enhanced services and supports added onto the traditional home health benefit. The added services could include personal care services, meal delivery, and respite care, among several others.

The Choose Home Act is a top legislative priority for NAHC. In addition, other supporting organizations include AARP, the Partnership for Quality Home Health Healthcare (PQHH), LeadingAge, the National Council on Aging (NCOA), the Moving Health Home Coalition and others.

Imminent legislative activity is not expected as attention will shift towards reelection campaigns during the summer and early fall. In the meantime, NAHC will continue to build knowledge of the legislation on Capitol Hill, as well as add new supporters to optimize the Choose Home Care Act‘s chances of coming up for a vote.

NAHC encourages all members and home care professionals to urge their Senators and Representatives to support the bill. This can easily be done through the NAHC Legislative Action Center here.

Hospice Notes for July 13, 2022

Congress is facing a packed few weeks in the lead-up to the monthslong August recess. The potential revival of a slimmed-down reconciliation package sought by Senate Democrats remains top-of-mind for many DC watchers. While nothing is concrete at this point, it unfortunately appears likely that any smaller party-line reconciliation bill will omit major funding investments in Medicaid home-and-community-based services (HCBS). Last year’s House-passed Build Back Better Act included $150 billion for HCBS, seen as a transformative injection of resources that would increase access and better support the frontline home care workforce.

NAHC continues to work with other diverse coalitions to push for the inclusion of HCBS funding in any emerging deal.

Elsewhere on Capitol Hill, the House Appropriations committee recently approved a number of FY2023 government funding bills, including the Labor, Health and Human Services, Education, and Related Agencies (LHHS) package that contains discretionary spending for federal health programs. While it is certain that future Senate-side bipartisan negotiations will ensure any final government funding package that will ultimately become law will differ from what the House Appropriations committee has cleared, it is still instructive to keep track of the Democrat-led House deal, as it provides insight into that group’s policy priorities. A few provisions relevant to home-based care providers, detailed in the bill’s accompany report, include the following (note -many of these are merely signaling in nature, as opposed to explicitly directive):

  • Medicare Coverage of Home-based Extended Care Services.—The Committee encourages CMS to consider options to improve extended care services for Medicare beneficiaries, such as through home-based extended care by home health agencies (bottom of pg 184)
  • Patient Access to Home Health Care.—The Committee supports the intent of the network adequacy rules of CMS for Medicare Advantage organizations and for Medicaid managed care organizations under 42 C.F.R. 438 and 457 to maintain a network of qualified providers sufficient to provide adequate access for covered services to meet the health care needs of the patient population served. The Committee requests a report within 180 days of the date of enactment of this Act on regulatory actions related to network adequacy (bottom of pg. 186)
  • Home Health Aides.—The Committee recognizes that home health aides (HHAs) are the foundation of professional home-based caregiving, and that the growing population of disabled, chronically ill, and elderly Americans receiving home-based care requires a skilled and highly trained HHA workforce prepared to manage complex care needs. The Committee encourages HHS to explore how HHAs are meeting clinical competencies necessary to provide high-quality home-based care (pg. 221)
  • Direct Care Workforce Demonstration.—The Committee provides $3,000,000 for a Direct Care Workforce Demonstration project, to reduce barriers to entry for a diverse and high-quality direct care workforce, including providing wages, benefits, and advancement opportunities needed to attract or retain direct care workers. (pg. 211)
  • Dementia Care Management Model.—The Committee urges the Center for Medicare & Medicaid Innovation (CMMI) consider how best to test a Medicare dementia care management model. The Committee encourages CMMI to continue working with stakeholders to find a way to test a value-based dementia care management model that could reach dementia patients across the stages and include coordinated care management and caregivers. The Committee requests an update not later than one year after the date of enactment of this Act on the progress for this model. (pg. 180)

The bill also includes several provisions that would help to increase the health care workforce. Among other things, the bill includes: nearly $2 billion in new money for the Department of Labor, including for apprenticeship programs, Workforce Innovation and Opportunity state grants, and Senior Community Service Employment; $15,6 billion in new money for HHS to enhance nursing workforce development and other health care programs; and enhanced funding for targeted programs of the Administration on Community Living.

The Committee also adopted a manager’s amendment from House Appropriations Committee Chairwoman Rosa DeLauro (D-CT), that added language to the committee report that urges the Health Resources and Services Administration  (HRSA) to “address the skilled care workforce needs of seniors through existing workforce education and training programs.”

The most hospice and palliative care-specific bills in Congress right now include the Palliative Care and Hospice Education and Training Act (PCHETA) (S.4260) and the Expanding Access to Palliative Care Act (S. 2565). PCHETA would bolster the serious illness professional workforce and boost palliative and hospice research funding, while S.2565 would require CMMI to test a dedicated community-based palliative care demonstration informed by the recently-ended, hospice-only Medicare Care Choices Model (MCCM). Both bills are currently Senate-only at this point, and we need your continued advocacy and outreach to continue to garner co-sponsors for these important policies. Use NAHC’s grassroots outreach campaigns to ask your Senators to support these bills.

Elsewhere in DC, much of the policy conversation on palliative care in particular is occurring within CMMI. In light of the Innovation Center’s strategic refresh late last year, it has become apparent that leadership there is focused on streamlining their demonstration portfolio and developing ways to better integrate specialty care (which is how they conceptualize palliative care) into broader, population health-style models, primarily the ACO programs.

Recently, CMMI posted a blog that broadly spells out their early vision for this kind of integration. In the piece, they specifically write: “Until more ACOs can assume full risk, collaborative care codes, as currently used in behavioral health, could support integration and co-location of some specialty care, such as palliative care.”

NAHC, in tandem with other members of the National Association of Hospice & Palliative Care, continues to work with CMMI to explore how best to support and scale home and community-based palliative care.

Hospice Care Index Technical Report Released

Abt Associates submitted the Hospice Care Index Technical Report to the Centers for Medicare & Medicaid Services. The report provides context and descriptive analyses for the Hospice Care Index (HCI). The HCI is a new quality measure for the Hospice Quality Reporting Program (HQRP) that will be publicly reported on Care Compare in August 2022. The measure was added to the HQRP in 2022 and is a single measure comprising ten indicators calculated from Medicare claims.

The ten claims-based indicators comprising the HCI are shown below.

Hospices have had concerns about the indicators seemingly focusing more on program integrity issues than quality of care.  CMS repeats in this report what it has said in the past – that the HCI provides a broad overview of hospice care quality. CMS further explains that each indicator in the index represents a particular care practice of concern, as identified by CMS’ information gathering activities and that the HCI was developed to fill several identified information gaps:

  • Provision of Higher Levels of Hospice Services:

CMS requires hospices be able to provide both continuous home care (CHC) and general inpatient care (GIP) to manage more intense symptom crises. However, around a quarter of all programs do not provide GIP services each year, and it is unclear if patients in crisis received appropriate care (a similar concern exists regarding the CHC level of care.)

  • Visits by Professional Hospice Staff:

Medicare Conditions of Participation (CoPs) require the hospice interdisciplinary team to ensure on-going patient and caregiver assessment, plan of care implementation, and 24/7 availability of hospice services. Additionally, the end of life is typically the period in the terminal illness trajectory with the highest symptom burden, necessitating close care and attention from hospice staff.

  • Patterns of Hospice Live Discharges and Transitions:

Providers are expected to have some live discharges, but rates that are substantially higher than other hospices could signal a potential problem such as poor care quality, poor program integrity, failing to meet patients’ or families’ needs, or admitting patients who do not meet  eligibility criteria. Atypical transition patterns suggest problems in hospices’ care processes, advance care planning to prevent hospitalizations, or discharge processes. Revocations may also be related to business practices or quality of care.

  • Medicare Spending:

CMS currently reports per-beneficiary spending estimates for other care settings. Half of hospice expenditures are for patients that have had at least 180 or more days on hospice, raising concerns that some programs do not appropriately discharge ineligible patients, enroll patients with longer predicted lengths of stay in hospice, or inappropriately bill for highlevel, higher-rate services such as GIP.

Per CMS, the indicators represent a hospice’s ability to address patients’ needs, best practices hospices should observe, and/or care outcomes that matter to consumers. Each HCI indicator has its own numerator, denominator, and resulting indicator score. A hospice earns a point each time it meets the threshold for an indicator. Hospices’ HCI scores are calculated as the total number of earned points across the ten indicators and can range from a perfect 10 to a 0.  Index Earned Point Criteria were set based on CMS’ statistical analysis of national hospice performance to ensure meaningful distinction between hospices. It is only the Index score that will be publicly reported in August, but hospices can see their performance compared to norms in the Provider Preview Reports available in their CASPER folders.

For this recently released technical report, 100 percent of Medicare Fee-For-Service (FFS) claims data from eight quarters across calendar years 2019 through 2021 were used by CMS to calculate scores for the ten indicators and the overall index to assess the HCI against National Quality Forum (NQF) performance standards for validity and variability. Nationally, the average HCI score is 8.8, with 37.9 percent of hospices receiving a score of 10. No hospice scored a two or below. The report states that the  range of scores indicates sufficient potential to differentiate hospice performance which is one of CMS’ goals for quality measures.

In general, HCI scores were higher on average among larger hospices, older hospices, non-profit hospices, and facility-based hospices. Scores were also higher on average among hospices in northern states. There was not a strong difference in average HCI scores between hospices in urban and rural areas. CMS found a correlation between a higher HCI score and a higher percentage of caregivers reporting that they would recommend the hospice (through the CAHPS® Hospice Survey).  The report provides details of the correlation between indicators, the likelihood of HCI indicators for which hospices failed to achieve points and the HCI indicators’ relationships to CAHPS® Hospice outcome scores.  The report also provides details about the design and structure of the HCI including the rationale for the indicators and a scoring explanation.

Choose Home Care Act Picks Up Support in Congress

Click Here to Urge Congress to support the Choose Home Care Act! The Choose Home Care Act continues to build support in Congress with the recent addition of new cosponsors in the House of Representatives, including Reps. Sheila Cherfilus-McCormick (D-FL-20), Brian Fitzpatrick (R-PA-1), Al Lawson, Jr. (D-FL-5), and Angie Craig (D-MN-2). We thank the new sponsors of this…

Hospice Care Index Technical Report Released

Abt Associates submitted the Hospice Care Index Technical Report to the Centers for Medicare & Medicaid Services. The report provides context and descriptive analyses for the Hospice Care Index (HCI). The HCI is a new quality measure for the Hospice Quality Reporting Program (HQRP) that will be publicly reported on Care Compare in August 2022.…