Literature Review

Lawmakers say CMS should ban Medicare Advantage’s use of AI to deny care McKnights Long-Term Care News; by Josh Henreckson; 6/26/24 The Centers for Medicare & Medicaid Services should consider banning artificial intelligence from being used to deny Medicare Advantage coverage pending a “systematic review,” a group of 49 congressional leaders is urging. ...  Skilled nursing providers have been sounding the alarm for years on Medicare Advantage coverage access, especially when informed by AI and other algorithms. Sector leaders have frequently noted that these methods can deny or prematurely end coverage for patients who need it to afford necessary long-term care. Providers and consumer advocates both spoke out in favor of the lawmakers’ letter this week. “LeadingAge’s nonprofit and mission driven members … have firsthand experience of Medicare Advantage (MA) plans’ inappropriate use of prior authorization to deny, shorten and limit MA enrollees’ access to medically necessary Medicare benefits,” wrote Katie Smith Sloan, president and CEO of LeadingAge. ... “Implementation by [the] Centers for Medicare and Medicaid Services (CMS), which we fully support, would ensure MA plans fulfill their obligation to provide enrollees equitable access to Medicare services.”

How the Supreme Court’s Chevron Decision could help stop home health cuts Home Health Care News; by Andrew Donlan; 6/28/24 On Friday, the U.S. Supreme Court upended the Chevron doctrine precedent. For home health industry purposes, that means a potentially weakened Centers for Medicare & Medicaid Services (CMS) moving forward. The news comes just two days after the home health proposed payment rule was released, which included significant cuts for the third straight year. Broadly, moving away from the Chevron precedent – usually known as the Chevron doctrine – will mean less regulatory power for government agencies. Government agencies often take their own interpretations of certain laws and statutes, and then act upon those interpretations. ... The National Association for Home Care & Hospice (NAHC) already filed a lawsuit against the U.S. Department of Health & Human Services (HHS) and CMS over rate cuts in 2023. “In our own analysis, we believe that providers of home health have been underpaid as it relates to budget neutrality,” NAHC President William A. Dombi said when the lawsuit was filed. “At minimum, we would expect to see the rate cuts from 2023, that were permanent readjustments to the base rate, and the one proposed for 2024, along with the temporary adjustments … to go away. The end product of that is that we would have a stable system to deliver home health services to Medicare beneficiaries.”

Delaware legislature passes Medical-Aid-in-Dying law CBS WBOC, DOver, DE; by Sean Curtis; 6/25/24 The Delaware State Senate is sending House Bill 140, or the End-of-Life Options Law, to Governor John Carney’s desk after passing it Tuesday [6/25/24]. ... Medical aid in dying would only be available to adult Delawareans diagnosed with an incurable disease or illness who have been given a prognosis of six months or less to live. The prognosis must come from at least two medical professionals, according to lawmakers. Advanced age, disability, mental illness, or chronic health conditions would not qualify a person, under the law. Those seeking medical aid in dying under HB 140 would need to demonstrate an ability to understand and grasp the consequences of their decision, as determined by a licensed psychiatrist or psychologist. ... It will now head to the Governor’s Office for Carney’s signature before becoming law, unless Carney chooses to veto the legislation. 

Lawmakers remain committed to passing hospice workforce bill Hospice News; by Jim Parker; 6/24/24 Federal legislators plan to continue to work on passing a bill designed to bolster the hospice and palliative care workforce. The Palliative Care and Hospice Education Training Act (PCHETA) has come before Congress several times but has not yet been passed. The bill’s most recent development occurred in July 2023, when it was reintroduced by Sens. Tammy Baldwin (D-Wisc.) and Shelley Moore Capito (R-W.Va.). Capito has indicated that the senators are not giving up on the legislation as they seek to ensure that hospice and palliative care providers are able to meet growing demand. ... The legislation would establish fellowships through new palliative care and hospice education centers to provide short-term, intensive training, as well as incentivized award programs across all the relevant disciplines. It also would support programs to develop career paths within the field.

Advocates rally in DC for the future of hospice: NHPCO and HAN amplify provider voices on Capitol Hill NHPCO; Press Release; 6/13/24 More than 100 hospice and palliative care advocates from across the country met with over 150 congressional offices this week to discuss key legislative and regulatory priorities for ensuring and expanding access to hospice and palliative care. The meetings were part of Hospice Action Week, hosted in Washington, DC by the National Hospice and Palliative Care Organization (NHPCO) and its advocacy affiliate, the Hospice Action Network (HAN). “The cornerstone of effective advocacy is storytelling. It’s about sharing why hospice holds personal significance and why serious illness and end-of-life care policy should resonate with our lawmakers,” said Logan Hoover, NHPCO’s VP of Policy & Government Relations. “From Hawaii to Rhode Island, advocates from 35 diverse states came to DC this year. The relationships they’re building with Members of Congress hold the potential to shape the future of the healthcare landscape.” 

H.R.8278 - Hospice Recertification Flexibility Act: Introduced to Congress Congress.gov; introduced by Rep. Carol Miller [R-WV-1] on 5/7/24; text released 6/10/24To amend title XVIII of the Social Security Act to extend certain telehealth flexibilities with respect to hospice care under the Medicare program, and to establish a modifier for recertifications of hospice care eligibility conducted through telehealth.

Experts urge Legislature to pass bill preventing for-profit and private equity hospice in New York Spectrum News 1; by Susan Arbetter; 5/21/24The FBI has issued public warnings about hospice fraud in four states — Texas, Arizona, Nevada and California. The bureau is alerting consumers to a wide-spread scam in which patients are enrolled in hospice without their knowledge by recruiters who “sell” hospice care to people who aren’t actually eligible. ...  One reason fraudsters have yet to gain a foothold in New York is that new hospices here go through a “Certificate of Need” process (CON) which reviews applications, provides for public comment and ensures that hospice operators don’t have a history of fraud or abuse. But according to Jeanne Chirico, president and CEO of the Hospice & Palliative Care Association of NYS (HPCANYS), and Kara Travis, president and CEO of Mountain Valley Hospice & Palliative Care, and a trustee of HPCANYS, there’s more that New York can do to protect consumers. They are urging lawmakers to pass a bill carried by state Sen. Liz Krueger and Assemblymember Amy Paulin that would prohibit the establishment of new for-profit hospices in the state (A6032 - Paulin / S6460 – Krueger).

Laws in motion to bring ‘Right to Try’ psychedelics at end-of-life Hospice News; by Holly Vossel; 5/21/24Hospice providers are navigating an evolving landscape of laws opening up pathways of access around psychedelic utilization at the end of life. Despite mounting evidence that psychedelics can improve experiences and reduce symptom burden in some terminally ill patients, these drugs remain difficult to access for those wishing to utilize them. Some states and the federal government have considered legislation that would establish a “right to try” psychedelics and other experimental interventions for certain seriously ill patients. 

Medical aid in dying bill didn’t cross finish line this MN Legislature session Twin Cities Pioneer Press; by Dene K. Dryden; 5/22/24 Despite advancing through several House committees, Minnesota’s End-of-Life Option Act did not receive a floor vote in the House or Senate during the 2024 legislative session, which ended earlier this week. The legislation, co-authored by Rep. Andy Smith, DFL-Rochester, and Sen. Liz Boldon, DFL-Rochester, would have permitted medical aid in dying, also known as physician-assisted suicide. The measure would have allowed terminally ill adults to request a prescription for life-ending medication, which they would have to self-administer. 

Senate ramps up push to reform doctors' Medicare pay Modern Healthcare; by Michael Mcauliff; 5/20/24Declining doctors' pay in Medicare is getting its most serious look in nearly a decade in the Senate, with a bipartisan push launched Friday by the Senate Finance Committee. Doctors have grown especially vocal in recent years about falling Medicare reimbursement. Groups including the American Medical Association have estimated doctors were effectively getting paid 26% less in 2023 than in 2001 because the physician fee schedule set by the Centers for Medicare and Medicaid Services is not adjusted for inflation. Physicians have also called for more flexibility within the pay system.

VA Committee leaders unveil bipartisan veterans packageHouse Committee on Veterans' Affairs; by Kathleen McCarthy; 5/14/24 House and Senate Committee on Veterans’ Affairs leaders Chairman Mike Bost (R-Ill.), Chairman Jon Tester (D-Mont.), and Ranking Member Jerry Moran (R-Kan.), introduced H.R. 8371, the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act. This legislation includes a number of bipartisan and bicameral proposals to reform and improve the delivery of healthcare, benefits, and services at the Department of Veterans Affairs (VA) for veterans, their families, and their survivors. ... The Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act is supported by a growing list of the following organizations: The American Legion [TAL] ... Wounded Warrior Project (WWP), ... Tragedy Assistance Program for Survivors (TAPS), ... National PACE Association, National Hospice and Palliative Care Organization (NHPCO), Hospice Action Network (HAN), and [many more].

NHPCO and HAN secure significant policy victories in Congress NHPCO; Press Release; 5/10/24This week marked a series of triumphs for the National Hospice and Palliative Care Organization (NHPCO) and its advocacy arm, the Hospice Action Network (HAN), in collaboration with the National Association for Home Care & Hospice (NAHC). Notably, the trade associations spearheaded discussions with the House of Representatives’ Ways and Means Committee, resulting in crucial advancements in telehealth flexibility for hospice care. The passage of the “Preserving Telehealth, Hospital, and Ambulance Access Act” through committee signifies a pivotal moment for the future of hospice care. ...HAN’s meticulous engagement with the Ways & Means Committee staff also successfully thwarted potential cuts, safeguarding the capacity of hospices to provide essential care to vulnerable populations. “With an aging population and escalating demand for end-of-life care, particularly in underserved regions, protecting hospice funding is imperative to guarantee compassionate and dignified care for all individuals in their final days,” said NHPCO COO and Interim CEO, Ben Marcantonio.Notable Mentions: Logan Hoover, NHPCO VP of Policy and Government Relations; Dr. Joseph Shega, Vitas' Chief Medical Officer

Lawmakers press nursing home chains on corporate spending amid staffing rule fight The Hill; by Nathaniel Weixel; 5/6/24Congressional Democrats demanded information about the corporate spending by the operators of three of the country’s largest public, for-profit nursing homes, after the companies said they can’t afford the Biden administration’s new minimum staffing threshold. In letters sent to the companies Sunday, ... [they] pressed for information about buyouts, dividends, and salaries to executives and shareholders. The lawmakers aim to contrast that with the salaries for nurses and nursing aides, amid widespread industry opposition to the new staffing requirements because they are too costly.