The Hospice CARE Act: A Landmark Reform for Medicare Hospice Benefits

In a move that’s sending ripples through the hospice care industry, Congressman Earl Blumenauer has introduced the Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act. This proposed legislation represents the most significant overhaul of the Medicare hospice benefit since its inception in 1982. For hospice providers, patients, and their families, the implications of this act could be far-reaching and transformative. 

The Hospice CARE Act aims to modernize a system that has remained largely unchanged for over four decades. In that time, the hospice landscape has evolved dramatically, both in terms of the providers delivering care and the patients receiving end-of-life services. However, this evolution has also exposed vulnerabilities in the system, leading to instances of fraud and abuse that have raised critical questions about the benefit’s design and implementation. 

As Congressman Blumenauer states, “Patients and families deserve better. We need a reset.” This reset comes in the form of comprehensive reforms targeting payment structures, program integrity, provider enrollment, quality care, and transparency. These changes are designed to protect patients, safeguard taxpayer dollars, and ensure that the hospice benefit can meet the needs of terminally ill beneficiaries and their families in the 21st century. 

In this blog post, we’ll cover the key aspects of the Hospice CARE Act, explore its potential impact on hospice providers, and discuss how SimiTree can help your agency work through these significant changes. Whether you’re a hospice administrator, a healthcare professional, or simply interested in the future of end-of-life care, understanding this landmark legislation is crucial. 

Background of the Hospice CARE Act  

As the release states, the proposal comes as egregious reports of fraud and abuse within the benefit persist, despite action from Centers for Medicare & Medicaid Services (CMS). The legislation is the product of years of collaboration between stakeholders, lawmakers, and industry leaders. It builds on Blumenauer’s decades-long commitment to ensure the federal government supports families at a time of great stress and vulnerability: the end of life.  

“The United States spends significantly more on health care than other developed nations for worse outcomes. Nowhere is this more egregious than in the hospice industry,” said Congressman Earl Blumenauer. “Patients and families deserve better. We need a reset. It is past time for Congress to act to end the fraud, waste, and abuse within the hospice benefit and bring it into the 21st century.” 

Do you have these in order? How SimiTree can help  

If you have all of the following in order, you’ll be well-positioned to align efficient and effective operations with regulations.  

SimiTree offers comprehensive support to hospice agencies navigating the changes proposed by the Hospice CARE Act and addressing ongoing compliance challenges. Our expertise spans various areas crucial for hospice agencies: 

Quality, Compliance, and Audit Support 

• Assist with prepayment reviews under the Provisional Period of Enhanced Oversight (PPEO) 

• Help respond to Additional Documentation Requests (ADRs), audits, and appeals 

• Conduct pre-bill audits and required HIPAA privacy assessments 

• Perform full mock surveys to prepare for actual inspections 

• Create individualized risk management plans 

• Develop robust Quality Assurance and Performance Improvement (QAPI) plans that drive continuous enhancement of operational efficiency and performance improvement  

Support Agencies in Addressing the “Top Four Problems” in eligibility and billing:  

• Ensuring accurate Notice of Election (NOE) and Hospice Election Statement 

• Addressing General Inpatient Care (GIP) denials 

• Preparing for the 90-day Noridian audit 

• Ensuring timely submission of Hospice Item Set (HIS) files 

• Financial management and consulting services 

Expert Guidance 

• Our compliance team includes former auditors and surveyors with extensive experience across healthcare settings 

• Team members are both ACHC and CHAPS certified 

• Provide insights on Medicare methodology and the medical review process 

Training and Education 

• Provide comprehensive training on Medicare regulations for hospice care 
  • Educate staff on their responsibilities and impact:  
  • Emphasize that all their work ultimately reaches CMS. What are they accountable for? Staff impacts every component of excellent hospice outcomes, from quality to finance.  
  • Highlight how each role contributes operationally for great clinical and financial outcomes 
  • Increase training on improving IDG, care planning, coordination of care, and outcomes 
  • Ensure staff understands their role in maintaining excellence in: 
    • Eligibility requirements 
    • Billing procedures 
    • Documentation standards 
• Keep agencies updated on the latest regulatory changes, including the Hospice CARE Act 

Operational Support 

• We compare your KPIs against national benchmarks and metrics that drive key financial and quality outcomes to assist in building a successful, sustainable, strategic plan 

• Help develop and implement robust compliance programs 

• Assist in reviewing and improving documentation practices 

• Provide complete assessment of clinical, financial, and quality programs 

Financial Management and Consulting Services 

• Offer hospice billing and collections outsourcing 

• Assist in navigating payment structure changes proposed by the Hospice CARE Act 

• Cost reporting & CAP reporting  

• Assist in understanding and utilizing their outcome data (Healthcare First, SHP, etc.)  

Clinical Consulting 

• Help improve IDG, care planning, coordination, and outcomes  

• Enhance clinical documentation to support eligibility and billing 

• Assist with understanding conditions of participation (CoPs) and aligning them with operational practice 

Technology and Data Management 

• Ensure proper submission and verification of HIS files/HOPE instrument  

• Assist in implementing systems for tracking and managing compliance requirements 

Ongoing Support and Monitoring 

• Conduct regular audits to identify potential compliance issues 

• Provide continuous support to adapt to evolving regulatory landscapes 

By focusing on these key areas, your hospice operation can maintain compliance while optimizing efficiency and effectiveness. 

By partnering with SimiTree, hospice agencies can confidently navigate the complex regulatory environment, including the proposed changes in the Hospice CARE Act. Our comprehensive approach helps agencies not only avoid penalties and audits but also improve their overall operational efficiency and quality of care. 

To learn more about how SimiTree can support your hospice agency through these changes and beyond, contact us at 800.949.0388 or visit our website to schedule a consultation with one of our experts. 

Additional Resources  

Full press release: https://bit.ly/4eBKaVY  
Fact sheet: https://bit.ly/4ebK1c5  
Contact us today: https://bit.ly/3sk70i5