Landmark Hospice Bill Draft Includes Nursing Home-Related Proposals

Rep. Earl Blumenauer (D-Oregon) on Thursday announced that a draft bill is underway that, if enacted, would bring unprecedented reforms for hospice payment and oversight.

The draft bill comes as more skilled nursing operators expand their hospice offerings, including by launching their own hospice businesses or more closely partnering with existing hospice providers.

Blumenauer announced the bill, the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act, on Thursday at the Elevate conference in Washington D.C., organized and hosted by Skilled Nursing News’ sister publication, Hospice News. Though the bill language is still in development, one proposal calls for allowing for transitional inpatient respite care for up to 15 days for patients that first elect hospice from a hospital stay (which may include a stay for observation). This would allow eligible patients to transition to hospice sooner from a hospital stay without first going to a skilled nursing facility.


“When people are coming on the benefit in that moment of crisis, they don’t necessarily have a plan,” Mollie Gurian, vice president of home-based and HCBS policy at LeadingAge, told Hospice News. “This would be giving more time for families to figure out what the best next step is, whether they need to go to a nursing home and they need to get the paperwork done for that, or assisted living, or just the family getting ready in the home environment for people to come home.”

About 21% of Medicare decedents who elected hospice care in 2019 received that care in nursing homes, according to a Center for Medicare Advocacy report. The Covid-19 pandemic created strains on the system, as infection control measures prevented some hospice providers from accessing SNFs. Coming out of the pandemic, a growing number of skilled nursing operators — including National Healthcare Corp. and Marquis Health Consulting Services — have added hospice service lines and otherwise took steps to expand access to hospice.

The Hospice CARE Act would also implement a temporary, national moratorium on the enrollment of new hospices into Medicare, to help stem the tide of fraudulent activities among recently established providers concentrated primarily in California, Arizona, Texas and Nevada.


“We would actually stop new enrollments until we have the chance to work this through, dealing with exceptions that need to be in place. We’re very interested in developing a transitional program, so that people are able to get the type of service they need on day one,” Blumenaur said at Elevate. “We’re going to take a hard look at what we’re doing with the per diem system … That’s going to have a modest amount of controversy, but I think it’s something that is long overdue and important.”

Among the key changes would be a reduction in hospice daily rates and the addition of a per-visit payment for clinical services to ensure that hospices are delivering appropriate care to patients.

The bill would also institute a payment add-on to support delivery of higher-acuity care palliative services that are difficult for hospice to support within the current payment structure. In the current draft of the legislation, this would include dialysis, chemotherapy, radiation and blood transfusions.

If enacted, the legislation would also prohibit payment to hospice programs that do not submit required quality data. Currently, about 20% of hospice programs do not submit quality data despite a 4% payment penalty for noncompliance, according to Blumenaur’s congressional office. It would also allow nurse practitioners to certify patients for hospice, among other changes to the Medicare benefit.

At Elevate, Blumenaur encouraged hospice providers to contact his office to express their views and needs when it comes to reforming hospice care, oversight and payment.

“This is an opportunity to do something in this Congress that is concrete, specific, that will save money and improve the quality of care for some of our most vulnerable people …” Blumenauer said. “This is an essential part of being able to humanize the health care system to improve patient outcomes.”

The legislation would also create new levels of respite care. Current regulations limit inpatient respite care to no more than five consecutive days. If the bill passes, it would allow for five inpatient respite days during per election period.

The bill would also create a short-term, home-respite level of care for when respite care is provided to individuals in their homes for at least eight hours during a 24-hour period for no more than five days during an election period, according to a discussion draft of the legislation.

“Congressman Blumenauer continues to be a valued thought leader in evolving the Medicare Hospice Benefit on behalf of hospice and palliative care providers, patients, and their families,” Ben Marcantonio, COO and interim CEO for the National Hospice and Palliative Care Organization (NHPCO), told Hospice News in an email. “We are grateful to him for his dedicated effort to advance serious illness and end-of-life care and look forward to providing feedback on the Hospice CARE Act.”

Like any major changes, these reforms, if they come to fruition, would require careful implementation, according to National Association for Home Care and Hospice President Bill Dombi.

“While we appreciate that this draft legislation can help support broader conversations about how best to improve the hospice program for all Americans, we want to make sure the proposed policies don’t unduly burden hospices following the rules and delivering quality care, and jeopardize timely access to care for the sickest among us,” Dombi told Hospice News in an email. “We will work with our members and partners to gather detailed feedback on the draft, and look forward to providing input to help inform legislation that recognizes the value hospice brings to patients, communities, and taxpayers.”

Each of the nation’s four largest hospice industry groups have committed to providing feedback to help shape the legislation as it progresses through Congress, including NHPCO, NAHC, LeadingAge and the National Partnership for Healthcare and Hospice Innovation (NPHI).

“We thank Congressman Blumenauer for his attention to the difficult challenges facing NPHI members and the broader hospice community. His release of the draft text of the Hospice CARE Act of 2024 is just the latest development in his years-long championing of high-quality end-of-life care,” NPHI CEO Tom Koutsoumpas told Hospice News in an email. “We look forward to working closely with the Congressman, his staff and committee staff to provide feedback on this detailed and thoughtful proposal.”

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