In The News

Advocates Rally in DC for the Future of Hospice: NHPCO and HAN Amplify Provider Voices on Capitol Hill


(Alexandria, VA) – More than 100 hospice and palliative care advocates from across the country met with over 150 congressional offices this week to discuss key legislative and regulatory priorities for ensuring and expanding access to hospice and palliative care. The meetings were part of Hospice Action Week, hosted in Washington, DC by the National Hospice and Palliative Care Organization (NHPCO) and its advocacy affiliate, the Hospice Action Network (HAN).

Hospice Action Week brings together leaders, advocates, and supporters from across the country to unite as one voice to drive positive, legislative change for the betterment of the Medicare Hospice Benefit. This year’s events included a virtual component, giving advocates who were not able to attend in person the opportunity to write letters of support to their Members of Congress on key policy priorities including program integrity measures, telehealth flexibilities, workforce issues, and more.

“The cornerstone of effective advocacy is storytelling. It’s about sharing why hospice holds personal significance and why serious illness and end-of-life care policy should resonate with our lawmakers,” said Logan Hoover, NHPCO’s VP of Policy & Government Relations. “From Hawaii to Rhode Island, advocates from 35 diverse states came to DC this year. The relationships they’re building with Members of Congress hold the potential to shape the future of the healthcare landscape.”

This year, advocates focused on a variety of key issues during their congressional meetings:

  • Protecting care for patients and families through program integrity efforts, fixes to the hospice Special Focus Program to ensure proper identification of poor-performing hospices, telehealth flexibilities, expansion of bereavement services, and ensuring access to care for our nation’s Veterans.

  • Making meaningful benefit improvements to increase access and advance health equity by addressing workforce crisis by allowing practitioners to perform at the top of their licensure, reforming the outdates six-month prognosis barrier, enabling concurrent care, and advancing health equity by removing structural barriers to care.

  • Innovation in serious illness care delivery and payment by building upon previous, successful demonstration models through a community-based palliative care benefit and ensuring a seamless ending to the hospice VBID component through support for providers.

  • Protecting access and expanding quality by ensuring providers can offer the right care at the right time by securing an adequate level of reimbursement and ensuring resources are going directly to patient care by eliminating burdensome regulations that jeopardize access while strengthening effective program integrity measures to increase care quality.

In addition to advocate meetings with congressional offices on Wednesday, Hospice Action Week also featured various other meetings of hospice and palliative care leaders from across the country…

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CMS: Home Healthcare Spending Estimated to Grow by 7.1 Percent from 2025 to 2026, Surpassing Other Sectors

McKnight’s Home Care | ByAdam Healy
National spending on home healthcare is projected to grow faster than any other health sector in the years ahead, according to newly published data from the Centers for Medicare & Medicaid Services’ Office of the Actuary.
Between 2025 and 2026, national spending on home health care is expected to increase by 7.1%, a data analysis published Wednesday in HealthAffairs revealed. Projected spending growth in home health care should outpace all other categories including hospital care services (4.9%), physician and clinical services (4.8%) and nursing homes care (4.8%), and it is expected to grow even faster during the following years. Between 2027 and 2032, the sector will see spending growth of 8.1%, compared to hospital spending (5.6%), physician and clinical services (5.5%) and nursing home care (6%).
In 2022, home health spending increased by roughly 6%, CMS disclosed in a previous report.
Despite the pace of growth, home healthcare remains a relatively small spending category. CMS’ projections indicated that roughly $177.5 billion will be directed toward the segment in 2026. That compares to larger categories such as hospital care ($1.7 trillion), physician services ($1.1 trillion) and nursing home care ($237.6 billion). By 2032, home healthcare is expected to benefit from $282.7 billion in healthcare spending, while hospitals and nursing homes could see $2.3 trillion and $337.4 billion, respectively…

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Request for Data/Info on Hospice Virtual F2F Visits - for Congressional Advocacy

NAHC is trying to gather data and information from hospice agencies on the current legislative flexibility that allows hospices to perform the face-to-face (F2F) eligibility recertification visit using telehealth. We need this data in order to support our congressional advocacy to extend this flexibility, either temporarily (i.e., another two years) or permanently.

Despite robust previous and current advocacy and education on the utility of virtual hospice F2F visits, there are some stakeholders on Capitol Hill who harbor concerns that this allowance to do the F2F via telehealth is a fraud/program integrity risk that might fuel greater numbers of inappropriate recertifications of ineligible patients that could result in longer lengths of stay and higher rates of live discharges.

We believe these concerns are misplaced and do not reflect the reality of how virtual F2F visits are being used today. Nevertheless, we want to be responsive to the questions we are getting from the Hill about this. To that end, please complete the following short survey by the end of the month 06/30/24:

Thank you,

HHAC Board & Staff


House Energy and Commerce Committee Examines Medicaid Legislation, 80-20 Moratorium


On Tuesday, April 30th, the Health subcommittee of the House Energy and Commerce Committee held a hearing on Legislative Proposals to Increase Medicaid Access and Improve Program Integrity. The hearing’s sole witness was Daniel Tsai, the director of Medicaid within the Centers for Medicare and Medicaid Services (CMS), who provided perspective on the Administration’s priorities regarding Medicaid coverage, eligibility, and access to services.

Importantly, the hearing included legislation that would prohibit CMS from enacting the 80-20 passthrough provision within the Medicaid Access rule among the 19 bills examined during the session. During the session, lawmakers showed the stark partisan divide over the Access rule, with Republicans consistently advocating to repeal 80-20 and Democrats lining up to support the policy.

Opening statements from Committee Chair Rodgers (R-WA) and Guthrie (R-KY) criticized the proposal and expressed concerns about the unintended consequences of the provision. In contrast, Committee ranking member Pallone (D-NJ) and subcommittee ranking member Eshoo (D-CA) supported the passthrough requirement, praising the Administration for implementing the policy.

Many of the questions posed by lawmakers to Mr. Tsai dealt directly with the 80-20 requirement, including inquiries on the basis for the provision, what CMS expected the outcomes to be, and requests for more information about the data and analysis used to establish and justify the threshold. Reps. Dunn (R-FL) and Harshbarger (R-TN) specifically probed for information regarding CMS’ understanding and calculations regarding how they define the HCBS provide operating margin and CMS’ concerns about provider expenditures that prompted the regulation.

Notably, while Director Tsai repeatedly stressed that they utilized data and analysis to inform their decisions, no specific information was provided regarding the data sources, analyses, and outcomes.

Bills discussed during the hearing also included a number of other important pieces of legislation that would improve Medicaid, including proposals that would:

  • Make Money Follows the Person and Spousal Impoverishment Protections permanent;
  • Remove the Age 65 limit on the Ticket to Work Medicaid Buy-in for workers with disabilities;
  • Remove the requirement that an individual need an institutional level of care in order to qualify for home and community-based services under a Medicaid waiver; and
  • Remove the requirement for states to collect assets from the estate of older adults who received Medicaid services.

Information about the Hearing including text of the legislation and a recording of the proceedings is available online at:


CMS Revises Hospice Certifying Physician Enrollment Requirement Implementation Guidance


On June 6, 2024, in response to concerns raised by NHPCO and NAHC, CMS retracted its guidance indicating that any individual who elects to receive hospice services in a subsequent hospice election would need to be certified as if entering hospice in the initial benefit period. As we shared in our member alert yesterday, this guidance, published in a Hospice Certifying Enrollment Questions and Answers (Q & A) Document, contradicted Section 1814(a)(7) of the Social Security Act (SSA) and regulations at 42 C.F.R. § 418.22(c)(2). The SSA and regulations indicate that the attending physician must only certify a patient’s terminal illness for the initial hospice Medicare benefit period; and that only one physician, not both the attending and hospice physician, must provide this certification for subsequent benefit periods. See our statement in response.

Prior Guidance:

Q: Does this certification requirement also apply regarding beneficiaries who had been previously discharged during a benefit period and are being certified for hospice care again to begin in a new benefit period?

A: Yes. Any individual who revoked, or was previously discharged from, the hospice benefit, and then reelects to receive the hospice benefit in the next available benefit period, will need to be certified as if entering the program in an initial benefit period---and the certifying physician(s) must be enrolled or opted-out as specified above.

Revised Guidance:

Q: Does this new requirement change who can certify for hospice services?

A: Except for the new enrollment or opt-out requirement, nothing is changing under 42 CFR § 418.22 regarding who may certify the patient’s terminal illness.

This retraction ensures alignment with existing law and regulations, alleviating confusion among hospice providers, Medicare Administrative Contractors (MACs), and electronic medical record (EMR) vendors. View the updated Q&A Document.

Next Steps:

While we appreciate CMS's immediate response to our concerns, NHPCO and NAHC will continue to engage with the agency on outstanding issues associated with the implementation of the physician enrollment requirement. To support our members’ efforts to navigate through remaining inconsistencies in certifying physician enrollment regulatory guidance, NHPCO and NAHC developed a Physician Enrollment Requirement FAQ and Guidance tool.

As we shared in our prior alert, NHPCO and NAHC are also hosting a joint webinar on June 18 to review the current implementation status of implementation, share what we know, insights on initial challenges and best practices, and address common questions.

Navigating the Hospice Certifying Physician Enrollment Requirements Latest Updates and Q&A

June 18, 2024

1:30 – 2:30 p.m. MT


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