House introduces HOSPICE Act

Legislation | February 11, 2020 | by Mollie Gurian

On Monday February 10th, Congressman Jimmy Panetta (D-CA) and Congressman Tom Reed (R-NY) introduced the Helping Our Senior Population in Comfort Environments Act or HOSPICE Act (H.R. 5821). The HOSPICE Act was developed in response to the July 2019 Office of Inspector General (OIG) reports that identified several concerns in the hospice program related to the survey process and quality of care. LeadingAge and our partners VNAA/ElevatingHOME worked in coalition with other hospice stakeholders to formulate joint recommendations for the Congressional staff that worked on the legislation, many of which impacted the final version of this bill.

The HOSPICE Act will make several changes to the hospice survey process as well as introducing intermediate remedies into the hospice program. Broadly speaking, the bill addresses hospice survey transparency, consistency, and frequency, education of both consumers and surveyors, and the authorization of new remedies. This article highlights some key elements of the legislation.

Transparency

The OIG made the following recommendations related to public transparency of survey and certification information: (1) CMS should expand information reported by accrediting organizations (AOs) to make it more comparable to the data reported by State agencies; (2) CMS should seek statutory authority to make information from AOs publicly available (on Hospice Compare or a similar resource) and, once authority is obtained, make them publicly available; and (3) CMS should include (on Hospice Compare or a similar resource) survey reports or a compilation of important survey findings from State agencies and make the information more readily available and accessible in a user-friendly way.

The HOSPICE Act follows through on all these recommendations. Critically for members is that the bill does instruct that AOs submit the same information as State and local surveyors so that the information that is displayed to consumers is comparable across entities. The Secretary is instructed that the data that is posted prominent for consumers is easily accessible, and understandable. There is also a provision in the legislation instructing the Secretary to create programs to measure and reduce inconsistency of surveys.

Survey Frequency

The HOSPICE Act would change the frequency of surveys from three years to two years. We do not support this blanket approach where survey frequency is increased for all hospice providers. We recommended that the legislation require frequent surveys for new hospice providers and for those providers who are found to have serious deficiencies. This more targeted change to survey frequency is the one taken in the Senate version of this bill and we will continue to advocate for that approach.

Training

We worked to add a provision on surveyor training to the legislation that mandates the development of a comprehensive surveyor training program, minimum requirements for the survey team, and that the training must be completed prior to being allowed to participate on a hospice surveying team.

Remedies

The OIG recommendation was to seek statutory authority to establish additional, intermediate remedies for poor hospice performance. The HOSPICE Act establishes this authority and instructs the Secretary to develop procedures for and implement a range of remedies in the hospice program along with appropriate procedures for appeals. One of the specific remedies named in the bill is civil monetary penalties (CMPs). LeadingAge opposed and will continue to oppose the additional of CMPs to the hospice program. We also advocated for the inclusion of a report on the impact of the intermediate remedies which will be conducted by the Government Accountability Office (GAO) three years after the implementation of the remedies. The report will look at the frequency of application of each type of remedy and the impact of the remedies on access to and quality of hospice care.

Markup

The Ways and Means Committee marked up the bill on Wednesday Feb 12th and no major changes were made during this process. The bill is estimated to save 180 million dollars over 10 years. The bill’s lead cosponsors, Representatives Panetta and Reed, both mentioned their appreciation for the collaboration of the hospice stakeholder community in the drafting of the bill during their opening remarks. Several members of the Committee discussed positive personal experiences with hospice and expressed enthusiastic support for the legislation, including the provisions around surveyor education and transparency that we advocated to be added to the bill. The bill passed favorably out of the Committee.

We sent a letter to the Ways and Means Committee in advance of the markup supporting aspects of the bill and as well as emphasizing the pieces of the bill that we cannot support. We will continue to advocate on this legislation as it moves through Congress and to keep you informed on the process.