Hospice Policy Landscape: Look Back, Look Forward
A Look Back at 2020
2020 presented a year of challenges, dominated by the COVID-19 Pandemic and with the staunch support of hospice and palliative care advocates, the Hospice Action Network worked tirelessly to ensure that hospices have the resources they need to continue to provide high quality care during this public health emergency.
On March 27, 2020, the House passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act , aimed at providing much needed relief at the beginning of the pandemic. This bill established the Provider Relief Fund, which offered federal monies to Medicare providers including hospice and palliative care providers. The HAN team advocated for the inclusion of telehealth for hospice recertification and Medicare sequestration relief during the Public Health Emergency, both were included in the legislation
In addition to these flexibilities, NHPCO has advocated for the extension of the Public Health Emergency on which these flexibilities rely.
Other regulatory flexibilities NHPCO secured include 1135 waivers, including audio-visual telehealth for recertification for hospice, audio-only telehealth flexibility for advance care planning, and other flexibilities. Furthermore, we secured a pause of Targeted Probe and Educate (TPE), although postpayment medical review by the Medicare Administrative Contractors (MACs) has resumed for some topics identified by CMS. There have also been delays in cost reporting filings, and clarifications for initial and comprehensive assessments.
Throughout the pandemic, NHPCO has secured CMS guidance on nursing homes and hospice providers, and sought and received prioritization of hospice for PPE, tests, and vaccines. NHPCO also received clarification from CMS that fundraising and thrift store revenue can be accounted for as lost revenue for Provider Relief Fund Reporting purposes, as well as other Provider Relief Fund Reporting Guidance.
Most recently, the 2020 end-of-year package, the Consolidated Appropriations Act, 2021, included hospice policies which will expand access to and improve quality of care, including:
- The Rural Access to Hospice Act, which will expand access to hospice in underserved communities by allowing physicians providing care in Rural Health Centers and Federally Qualified Health Centers to act as attending physicians for patients choosing hospice.
- The HOSPICE Act, which includes training and education for hospice surveyors, so they can ensure the quality of patient care.
- The IMPACT Act, which adjusts the calculation of the hospice aggregate cap and applies the hospice payment update percentage rather than the Consumer Price Index for Urban Consumers to a cap for FY 2026-2030.
- Extension of Medicare Sequestration Relief through March 31, 2021
- Finally, throughout the year, NHPCO mobilized broad support for a potential Community-Based Palliative Care Demonstration Model, and advocated for the delay of the implementation of the Medicare Advantage Value-Based Insurance Design for hospice.
Other changes came with the November election. All 435 seats in the United States House of Representatives and 33 of the 100 seats in the United States Senate were contested.
In the end, Democrats retained control of the House, with a slim 11-seat majority, and took control of the senate.
Raphael Warnock and John Ossoff, both Democrats, won their races in the Georgia Senate run-off election on January 5th against incumbent senators Kelly Loeffler and David Purdue. This means that Democrats will gain control of the Senate, with a 50-50 party split, and Vice President Kamala Harris acting as the tie-breaking vote. Harris, a former senator, was replaced by the newly-appointed senator Alex Padilla.
Last but not least, President Joe Biden was elected President and since being sworn in on January 20, 2021 has appointed several members of his transition team and administration who could have a potential impact hospice and palliative care federal policy under this new administration. President Biden has named California Xavier Becerra as Secretary of Health and Human Services, Former UN Ambassador Susan Rice as Director of the Domestic Policy Council, Neera Tanden as Director of the Office of Management and Budget, and Jeff Zients as COVID-19 Czar.
2021 Federal Policy Landscape
What can you expect from Congress in 2021?
To start, due to these changes in Congressional Leadership, our hospice and palliative care champions will have to reintroduce all legislation that did not pass in the 117th Congress. This includes:
- The Palliative Care and Hospice Education and Training Act (PCHETA)
- The COVID-19 Hospice Respite Care Relief Act
- The CONNECT Act
HAN will work with the sponsors of these bills and support their reintroduction.
Other proposals we will set forth in the 117th Congress relate to improving the Medicare Hospice Benefit. Highlights include:
- Changes to the six-month terminal prognosis requirement
- The availability of concurrent, curative care, and
- Upstream access to and payment for community-based palliative care
Check out the Hospice Action Network Website for detailed information and updates regarding legislation.
How Can You Get Involved?
One of the most important things you can do as an advocate is contact your legislators. HAN has action alerts active now, which you can use to call on your representatives to support
Lastly, please join us at NHPCO’s 2021 Leadership and Advocacy Conference from March 22-26, 2021. This year, the LAC will be held virtually online. For more details regarding the 2021 Leadership and Advocacy Conference, visit the NHPCO website.
On January 3rd, freshman and returning Members of Congress were sworn in. As members acclimate to their new roles, you should congratulate them on their success, and introduce yourself as a constituent from their district and state. Also, be sure to rekindle relationships with existing Members of Congress who are now more senior or who may have changed Committees.
Check out our Advocacy Toolkit on the HAN website to find your Member of Congress, sample introduction letter templates and emails, and other useful advocacy tools, and advocate for vaccine prioritization.