Rep. David Schweikert (R-Ariz.) has introduced the Medicare Advantage Reform Act, which among other provisions would require health plans to pay for hospice care.

If enacted, the bill would make wholesale changes to the Medicare Advantage program. It would mandate capitated payment models, change risk adjustment methodologies and create new exemptions for physician self-referrals, among other provisions.

Mollie Gurian VP of Policy and Government Affairs at LeadingAge called the bill overall “very ill conceived,” in an email to Skilled Nursing News’ sister publication, Hospice News. 

“It would reduce beneficiary choice and access to care via MA default enrollment, which would lock beneficiaries into one MA plan for three years even if plan benefits, provider networks or costs to the enrollees change annually,” she said. “Not allowing beneficiaries to change plans would likely create less competition and plan accountability for access to care in the marketplace.”

Nursing homes currently struggle with Medicare Advantage plans, Gurian noted, and the bill would further burden providers.

“While reforms are needed, these are not the right reforms and frankly, these would decimate both the MA plans and providers trying to provide care. Choice has been a fundamental piece of the Medicare program and one that needs to continue,” she said. 

The potential impacts of moving hospice into Medicare Advantage at this time would be “devastating,” according to the National Alliance for Care at Home.

“Congressman Schweikert’s bill (HR 3467), while attempting to bring about wide-ranging changes to how Medicare Advantage operates, would also dismantle this vital program by forcing hospice care into Medicare Advantage plans,” an Alliance spokesperson told Hospice News.

Potential consequences of the bill could include delays that could leave patients dying without support, restricted provider networks limiting choice, diluted services undermining the unique interdisciplinary hospice program and financial burdens on families, the Alliance indicated in the statement.

Schweikert introduced the bill on May 15, and the legislation was referred to the Ways and Means Committee of the U.S. House of Representatives. The Congress member’s office did not respond to inquiries from Hospice News.

As of Wednesday the bill text was not yet available online, pending a review by the Government Publishing Office. To date, no companion bill has been introduced in the Senate.

Currently, coverage for MA enrollees transfers to fee-for-service Medicare when they elect the hospice benefit.

This is not the government’s first attempt to work hospice into Medicare Advantage. The highest profile example was the hospice component of the Value-Based Insurance Design model (VBID), which ended Dec. 31, 2024.

The U.S. Centers for Medicare & Medicaid Services (CMS) cited operational challenges related to the hospice component that limited and decreased participation among Medicare Advantage Organizations (MAOs) and impacted “a thorough evaluation” of the demo.