Legislative Update: October 15, 2019

MedPAC Considers Hospice Cap and PAC Regulations
MedPAC (the Medicare Payment Advisory Commission) discussed policy options to modify the hospice aggregate cap and aligning benefits and cost-sharing under a unified payment system for post-acute care at their October 2019 meeting. MedPAC staff presented a new policy option for consideration – wage adjusting the hospice aggregate cap and lowering it by 20%. The cap limits aggregate payments a hospice can receive annually. If a provider receives payments in excess of the cap, those excess payments must be re-payed to the Medicare Trust Fund. The cap is statutorily set at $6,500 dollars and is increased annually for inflation so adjusting the cap amount would to be an Act of Congress. The 2020 cap amount is $29,965 and is not wage adjusted. The aggregate cap is stricter in some areas than in others because it is not wage adjusted; therefore, hospices furnishing care in high wage index areas are more likely to exceed the cap than in lower-wage index areas. The cap functions as a mechanism to reduce payments to hospices with long stays and high margins. MedPAC found that 12.7% of hospices exceeded the cap in 2016 and overpayments were the equivalent of 1% of total hospice payments to providers.  View the complete article for details on LeadingAge policy recommendations.

President’s Executive Order Seeks More Uniformity Between Medicare FFS and MA Provider Rates
The President’s October 3rd Executive Order focuses on changes to Medicare policy, with two key provisions instructing the HHS Secretary to study and report to the President within 180 days (early April 2020) on how to transition Medicare fee-for-service (FFS) provider payments to a more market-based approach, where Medicare FFS payments “more closely reflect the prices paid for services in MA and the commercial insurance market.” These changes could potentially have adverse impact on beneficiary access and provider participation but would have to be approved through rulemaking prior to implementation.  The Executive Order also contains other provisions which appear to remove barriers to the use of health technologies, telemedicine and telehealth.  For details and LeadingAge analysis see the full article.

New CMS Abuse Icon in Nursing Home Star Ratings
Last week Tuesday CMS announced changes to the 5-Star Quality Rating System and Nursing Home Compare. Beginning October 23, nursing homes that meet certain criteria for abuse citations will have a special icon (an alarming-looking red stop sign with a white hand on it) on the Nursing Home Compare page to alert consumers to abuse issues. Application of the icon also caps on the health inspection star rating and automatically imposes a limit on the overall star rating. CMS will also remove 2 quality measures related to pain from Nursing Home Compare as a result of concerns related to the opioid epidemic. Details on changes are available from CMS.
Ways and Means Meetings On Home Health And Hospice
LeadingAge staff also representing ElevatingHome/ VNAA’s home health and hospice organizations met with Democratic and Republican professional staff on the Ways and Means Committee to discuss the home health payment bill (HR 2573), potential legislation in response to the Inspector General’s report on problems in the Hospice program (see more information below under hospice), and potential legislation addressing the IG’s report on abuse reporting by nursing homes.  The Committee is heavily focused on issues that have dominated discussion throughout this year – prescription drug costs (H.R. 3) and surprise billing.  ElevatingHome/ VNAA members can keep abreast of legislative activity by participating on the Monthly Health Policy Update Call with the States, hosted by LeadingAge policy leaders. Click here to review this month’s agenda and sign up for the call happening on Thursday, October 24th at 2pm Eastern.

LeadingAge ElevatingHome/VNAA Meet with CMS on Hospice Survey and Certification and Home Health. Staff took part in a feedback session with the hospice survey and certification team within the Quality Oversight and Safety Group at CMS on behalf of LeadingAge and VNAA/Elevating Home. CMS is collecting feedback to inform broader stakeholder engagement about the future of the hospice benefit. This effort was initiated based on the OIG reports but it is not the only driver. LeadingAge will be submitting feedback to CMS and will keep members informed of CMS' activity for hospice quality oversight.  Staff also met with Hillary Loeffler, Director of Home Health, Hospice, and HCPCS in the Chronic Care Policy Group in the Center for Medicare at CMS to discuss PDGM implementation. CMS reminds home health providers to get set up in a specific data system (iQIES) prior to January 1 to make the PDGM transition easier. LeadingAge will keep members informed as new information is released.

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