MedPAC Calls for 7 Percent Home Health Rate Cut

The Medicare Payment Advisory Commission (MedPAC) discussed a proposal to reduce the 2023 Medicare base payment rate for home health agencies by seven percent, during the commission’s annual December meeting. MedPAC staff presented to Commisioners information and recommendations from the 2021 benefit data, including the following points: Medicare margins for 2021 were 24.9 percent; All-payer margin in…

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):

NAHC Board of Directors Update: Strategic Plan & Personnel

A new strategic plan and the composition of the 2023 NAHC Board of Directors were both approved and finalized at the December 5th meeting of the Board. The strategic plan, which was announced at the 2022 Home Care and Hospice Conference and Expo in St. Louis in October, was also presented to NAHC membership for…

Home Care Industry Update

Register now! This is a virtual event, accessible online. Access instructions will be provided after registration. Dec 15, 2022 12:00 PM EST // 11:00 AM CST // 10:00 AM MST // 9:00 AM PST Join Polsinelli, and the National Association for Home Care & Hospice (NAHC) for a legal update tailored for the Home-Based Care Industry (home health,…

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.

We Give Thanks to You and All You Do This Thanksgiving

Thanksgiving is a very important time of reflection, centering on all the good that came from so many people in our lives over the past year. We each face so many challenges in our personal and professional lives, yet there are family, friends, colleagues, and others who remind us routinely how great it is to…

Notes from the Private Duty Advisory Council

NAHC’s Private Duty Advisory Council monthly meeting this week, featuring an update on NAHC’s advocacy efforts as well as potential policies being monitored from Co-chair Brittnei Salerno of La Jolla Nurses Homecare and Executive Director of Private Duty at NAHC Kristen Wheeler. Legislation being watched by the NAHC Advocacy Team includes:

NAHC President William A. Dombi reminded the group that these bills will need to be reintroduced next year for the new Congress. We are very unlikely to see any movement on this legislation during the lame duck session of the current Congress.

Council Co-Chair Brittnei Salerno of La Jolla Nurses Homecare and Private Duty Executive Director Kristen Wheeler shared updates on these items, as well as a regulatory update that may potentially affect providers in the Southeast United States. The US Department of Labor (DOL) announced a new initiative to better enforce violations of the Fair Labor Standards Act (FLSA). The campaign aims to improve compliance in Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.

“The US DOL is determined to ensure these workers are not denied any of their hard-earned wages. Our current initiative combines compliance assistance and enforcement to decrease violations by employers in the care industries,” said DOL’s Wage & Hour Division Regional Administrator Juan Coria. The initiative will focus on resources to educate care workers in the industry along with targeting the misclassification of workers as independent contractors. A public webinar hosted by the DOL on Thursday, November 17, 2022, will review the protections for care workers so that employers and workers alike will understand their rights and responsibilities currently protected by the FLSA. The states being targeted are a result of division investigators identifying violations in nearly 89 percent of investigations completed in home and nursing care completed between 2020 and 2022.

During the state share portion of the meeting, the Council discussed the recently passed $15 minimum wage for Medicaid direct service providers in Florida. Council member Maxine Hochhauser of LHC Group told the group that the Medicaid fee schedule increase simply does not cover the cost of providing services. Expectations are that many Medicaid recipients will no longer have access to care unless the reimbursement rates are increased. The Home Care Association of Florida has joined the Florida Assisted Living Association and the Florida Ambulance Association in challenging the state’s Agency for Healthcare Administration on this requirement, maintaining that the agency did not use a proper rule-making process to define “direct care” workers who would be affected by the wage change. Further information will be shared as it becomes available.

Council members that sit on various workgroups of the Home Care Action Alliance updated the group on the efforts of those groups. Meetings are in their final stages and Project Manager Pat Kelleher is compiling recommendations of the groups. An early December release of these recommendations and action items is on track.

NAHC’s Private Duty Summit is expected to come to fruition in 2023 as a “conference within a conference” at the Annual Conference & Expo in October. The summit will feature robust educational sessions and will be individually branded to ensure attendees understand the separation. However, attendees will also be allowed access to the keynote general sessions as well as the lively trade show hall.

Bill Dombi rounded out the meeting with an update on what’s happening on Capitol Hill with home care legislation.

Interested in being a part of the Private Duty Advisory Council in 2023? Let us know!

Care at Home Champion Billy Tauzin Wins Val J. Halamandaris Award

At the 2022 Home Care and Hospice Conference and Expo in St. Louis, Missouri, NAHC presented the Val J. Halamandaris Award for Caring, Innovation, and Inspiration to former Rep. Billy Tauzin (R-LA) in recognition of his years of service to his constituents in Louisiana and to the millions of Americans who continue to benefit from the…

CMS Final CY2023 Home Health Rule: Slightly Modified But Home Health Access Risks Remain

The Centers for Medicare and Medicaid Services (CMS) issued the Final Rule regarding Medicare home health services payment rates for CY 2023. As usual, the rule also includes a hodgepodge of non-rate related proposals as well. This article provides a summary of the Final Rule. NAHC will be providing more detail over the next week…

The State of the Direct Care Workforce Study Reveals New Insight to Recruit & Retain Care Workers

NAHC and MissionCare Collective (MCC) analyzed 67,000+ direct care workers to better understand the people delivering care across the United States Amid a national shortage of home-care workers that deepened during the covid-19 pandemic, a new study unveils fresh insights to increase workforce capacity and reduce turnover. The State of The Direct Care Workforce Study,…