In The News

Encouraging Grassroots Outreach to Congress to Oppose Hospice Cap Cut

Now is the time to ask our congressional delegations to not make major cuts to the hospice aggregate cap in any end-of-year legislative package being negotiated. As is often the case with large, year-end spending bills, there are many programs and policies Congress wants to “stuff in” to an omnibus funding package before the close of the year. In order to pay for all these priorities, lawmakers must identify “offsets” to fund them. A significant reduction of the hospice aggregate cap, as has been recommended by MedPAC in the past, is being considered for one such “offset”.

The easiest thing you can do right now is to use NHPCO’s Hospice Action Network https://www.hospiceactionnetwork.org/take-action/#/ or NAHC's online grassroots campaign page https://p2a.co/mhu6Q52 to send our Senators and Representatives an email message and/or tweet asking them to oppose a cut.

It is always most impactful if you can personalize the pre-filled message language to talk about local impact. If you have good relationships with your members of congress' staff, please also consider reaching out to them directly to register your opposition.

HHAC is attaching a 2-pager background document that NHPCO and NAHC have prepared together. This document, and the talking points below, should help support any advocacy you may be able to engage in. Click here to access the 2-pager.  

  • Patient access to care could be significantly reduced: a major cap cut would create disincentives to serve patients that have a more unpredictable disease trajectory, such as those with dementia and organ failure, thereby disenfranchising entire categories of patients’ access to the hospice benefit.
  • It could further exacerbate health disparities in hospice access and utilization: The individuals most likely to have their access to hospice impacted by the cap reduction (those with dementia and other neurological diagnoses) are also more likely to be from medically underserved communities that already have lower rates of hospice utilization.
  • It may result in increased overall spending by Medicare: Any proposal that could limit hospice use, such as the cap reduction, may result in increased overall spending for Medicare, as patients who might have been served by cost-saving hospice instead utilize more expensive and aggressive care such as hospital, ER, and skilled nursing facility services. Recent research has shown that hospice use by Medicare beneficiaries is associated with significantly lower total healthcare costs across all payers, including Medicare. 

Thanks so much for your help with this effort and for the work you are doing in the community. Please don't hesitate to reach out to HHAU with any questions.

 

ProPublica / New Yorker Magazine Article: How Hospice Became a For-Profit Hustle

As anticipated in last week’s newsletter, ProPublica and the New Yorker Magazine published an article on hospice care titled: “How Hospice Became a For-Profit Hustle”.

The almost 9,000 word article, which raises awareness about fraudulent activity under the Medicare hospice benefit, specifically cites alarming spikes in the number of newly certified agencies in CA, TX, NV and AZ. Unfortunately, the article also focuses on a nonprofit/for-profit division within the hospice community and brings attention to old court cases in a manner that could promote public distrust of hospice care.

There are bad actors in hospice, but they are small in number and need to be rooted out through state and national oversight bodies that have the tools to do it. In an effort to help bring attention to all the good being done by hospice, NHPCO has shared the attached talking points, which should help respond to any inquiries you may receive based on the New Yorker article.

 

Worker Shortages, Waiting List Inaccuracies Complicate HCBS Programs

McKnight’s Senior Living | By Kimberly Bonvissuto
 
The COVID-19 pandemic put a spotlight on fundamental, long-term challenges for state Medicaid home- and community-based services programs, but it also provided opportunities for change, according to a new Kaiser Family Foundation issue brief.
 
In 2021, states reported offering 255 waivers under Section 1915(c), the largest source of HCBS spending and the type through which assisted living operators often provide services, with an average of five waivers per state. The data are based on the 20th KFF survey of state Medicaid HCBS officials in all 50 states and Washington, DC, between April and September. 

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A Closer Look At The Millions Of People On HCBS Waiting Lists

Home Health Care News | By Patrick Filbin
 
More than half a million people across the U.S. were on state waiting lists for home- and community-based services (HCBS) in 2021.
 
But the number of states that have a waiting list for people who are in need of HCBS is the lowest it’s been since 2016 at 37.
 
However, HCBS waiting lists are often incomplete and sometimes inaccurate, making it difficult to quantify the unmet need for the services financed through Medicaid waivers.
 
In 2021, about 656,000 people were on HCBS waiting lists, according to the Kaiser Family Foundation (KFF). That’s lower than the nearly 820,000 individuals that were on Medicaid waitlists for HCBS in 2018.
 
Home- and community-based services are a way to fill gaps in care for seniors with complex medical conditions. Medicaid is often the main source of coverage for long-term services and supports (LTSS).
 
There are well over 2 million individuals receiving HCBS services, but the way waiting lists are calculated can be an unscientific process that can both overstate and understate unmet needs, according to KFF.
 
For example, not all states screen for Medicaid eligibility before adding people to HCBS waiting lists. That can inflate the number on a waiting list by adding people who may never be eligible for services.
 
In its most recent analysis, KFF found that over half of people on HCBS waiting lists lived in states that did not screen people on waiting lists for eligibility.
 
The only HCBS that states are required to cover is home health care, but states can choose to cover personal care and other similar services.
 
Waiting lists can also understate need. States choose which populations they serve through the Medicaid waiver and what resources they will commit.
 
People may need services, but if the state doesn’t offer them — or doesn’t offer them to people over 65, for example — those individuals would not appear on a waiting list.
 
“Even though HCBS waiting lists are an imperfect measure of unmet need, there are no other measures available,” KFF wrote in its summary. “Therefore, waiting lists remain a source of concern to policymakers, and proposals to eliminate them have been put forth by both Republicans and Democrats.”
 
Takeaways from KFF analysis…

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CMS Pressures States to Adhere to Upcoming HCBS Rule Deadline

McKnight’s Home Care | By Liza Berger

[Last] Thursday [was] the cut-off for states to submit corrective action plans (CAPs) for their home- and community-based services (HCBS) programs in advance of the March 17 HCBS regulatory deadline. But the Centers for Medicare & Medicaid Services is concerned that states are dragging their heels on the CAPs.

“Today’s conversation is in the name of information sharing, technical assistance, reiterating expectations that we are a partner in adhering to the settings regulation, and yet we’re quite serious that it needs to have meaning and beneficiaries need to be able to see their lives reflected in the in the words in the regulation,” Melissa Harris, deputy director for the Disabled and Elderly Health Programs Group, said earlier this month, according to the Inside Health Policy news outlet.

The warning comes as HCBS stakeholders have voiced concerns that a majority of providers are turning away referrals because of limited staff capacity, and the workforce crisis is putting a severe strain on resources. CMS officials have been adamant that workforce shortages are not a justification for not meeting basic civil right requirements such as access to food and freedom to have visitors.

If states anticipate they will be unable to come into compliance with the final rule by March 17, they have until Dec. 1 to submit CAPs, CMS has said. States’ CAPs should include details on which criteria they need more time to complete — excluding criteria that protect basic civil and constitutional rights.

In May, CMS issued a recalibrated strategy to help states comply with the HCBS final rule and the March 17 deadline.

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