Late Alarm  – Pending Hospice Aggregate Cut?

As Congress prepares its end-of-year omnibus package, HHAU has learned that a cut to the hospice aggregate cap is being considered in a list of possible “pay-for” items for year-end policies that they would like to enact.

NHPCO, NAHC and LeadingAge sent a letter to Congress last week, outlining issues that will occur if a cut is approved. Despite efforts, the National Partnership for Healthcare and Hospice Innovation (NPHI) told the group that they could not sign onto a letter opposing a cap cut.

A key part of the join letter states:

“While over 50 percent of beneficiaries have hospice stays that are a total of 18 days or less, the number of patients with much longer lengths of stay has increased in recent years. This is in part a result of the changing nature of the population choosing hospice, many more people with non-cancer diagnoses are choosing to utilize the MHB. To this end, MedPAC in 2020 first put forward their recommendation to wage-adjust and reduce the hospice aggregate payment cap by 20 percent across-the-board. However, enacting this change now will have the impact of pushing patients with long length of stay, especially patients with Alzheimer’s Disease and related dementias, out of the hospice care they need.

“On top of this most recent threat to the hospice benefit, Congress has also taken action in recent years to reduce hospice spending through policy that lowers the aggregate cap. In the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), Congress changed the methodology for how the aggregate cap is calculated each year. That methodology change has been extended twice now and accrued savings. Should this change be extended, we would ask that the savings it generates be used to fund additional targeted hospice program integrity efforts that will hone in on truly abusive behavior while not punishing the vast majority of high-quality providers.”

Even More Stormy Seas for Hospice

A few weeks ago, NAHC and NHPCO became aware of a ProPublica reporter who is working with the New Yorker on an article about fraud in hospice that is expected to be published in the near-term. The story was initially believed to focus on known issues in California, Texas, Nevada, and Arizona. However, it now appears that the scope of the story will be much wider than previously thought, and may also address hospice margins, dynamics between for-profits and non-profits, long lengths of stay, provision of insufficient care, false claims act suits, the hospice cap and more. With a potential cap cut pending, the timing of this story couldn’t be worse.

The four national hospice associations have written a letter to CMS Administrator Brooks-LaSure requesting a meeting and urging that the agency take action to address the proliferation of hospice agencies in a handful of states through the imposition of targeted moratoria and other actions rather than a blanket response across the nation.

See NHPCO’s Hospice Action Network Action alert and share with our representatives. Agencies may also consider responding to any misrepresentations in the pending news article with letters to the Editor. While cap cuts have successfully been averted in the past, the effort is becoming more difficult each year.