Overview
Title
To amend title XVIII of the Social Security Act to ensure the integrity of hospice care furnished under the Medicare program, and for other purposes.
ELI5 AI
The Hospice Care Accountability, Reform, and Enforcement Act of 2024 is about making sure people in hospice care, which is care for very sick people who might not get better, get the right help and treatments. It does this by checking how hospice caregivers do their jobs more often, making sure they follow the rules, and setting aside money to pay for these checks and give people more information about their care.
Summary AI
The Hospice Care Accountability, Reform, and Enforcement Act of 2024 aims to improve the integrity of hospice care under the Medicare program. It introduces a temporary freeze on new hospice enrollments, enhances oversight and survey frequency for certain hospice programs, and requires more stringent reporting and quality standards. Additionally, it outlines changes to payment structures for hospice services and ensures that patients receive appropriate information and care coordination when they elect for hospice services.
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AnalysisAI
The bill presented is formally titled the "Hospice Care Accountability, Reform, and Enforcement Act of 2024." Its primary objective is to enhance the integrity of hospice care services under the Medicare program. This legislation introduces numerous changes aiming to ensure responsible management and delivery of hospice care, adjusting payments, and enhancing oversight measures.
General Summary of the Bill
This bill seeks to amend specific sections of the Social Security Act to improve the delivery and financial management of hospice care under Medicare. Key provisions include implementing a temporary five-year moratorium on the enrollment of new hospice programs, resulting in increased oversight and transparency in ownership changes. The bill also adjusts the way hospice care is reimbursed, introduces requirements for medical assessments, and sets out reporting mandates for hospice providers.
Summary of Significant Issues
There are several significant issues within the bill:
Restricted Access: The temporary moratorium on new hospice enrollments could inadvertently restrict hospice care access in underserved regions unless carefully managed with well-defined exemptions.
Discretion and Consistency: The bill provides substantial discretion to the Secretary of Health and Human Services in lifting moratoriums or granting waivers. These discretionary provisions may lead to inconsistent applications or perceived favoritism without clear criteria.
Complexity in Payment Calculations: The language surrounding payment reforms is highly technical, which could result in confusion and misunderstandings among stakeholders. The complex nature of payment adjustments may also lead to administrative complications.
Administrative Burdens: Increased survey frequencies and revalidation requirements create additional demands on hospice programs—impacts that smaller providers might find challenging to manage financially.
Effectiveness of Oversight: While aiming to curb fraud, the criteria for targeting hospice programs for medical reviews based on "aberrant billing patterns" lack transparency, potentially leading to arbitrary enforcement.
Impact on the Public
Broadly, this bill is intended to safeguard the integrity and quality of hospice care provided through Medicare. By enforcing stricter oversight and transparency, the hope is to enhance patient care standards and reduce fraudulent practices. However, the implementation of a moratorium and increased administrative standards can lead to decreased availability and accessibility of hospice services in certain areas, particularly underserved communities.
Impact on Specific Stakeholders
Hospice Providers: The increased regulatory requirements may disproportionately burden smaller hospice providers, which might lack the resources to comply with extensive surveys, revalidations, and ownership notifications. These administrative demands could influence financial stability and service delivery.
Patients and Families: While the bill's intent is to protect beneficiaries from substandard care and fraudulent practices, the complexity and restrictions on new provider enrollments may limit patients' access to hospice services, particularly in areas with fewer existing options.
Regulatory Authorities: These authorities may experience an increased workload due to the heightened oversight and enforcement provisions, requiring more resources to manage implementation effectively.
By scrutinizing hospice care practices and emphasizing accountability and transparency, this bill targets significant reform in this critical area of healthcare. Yet, balancing regulatory measures with accessibility remains a central challenge to ensure intended benefits reach all beneficiaries equitably.
Financial Assessment
This proposed legislation, known as the Hospice Care Accountability, Reform, and Enforcement Act of 2024, includes several financial elements aimed at overseeing and reforming hospice care within the Medicare program. This commentary will focus on these financial aspects and relate them to some of the issues outlined.
Financial Allocations
The bill includes multiple provisions for specific financial allocations:
Funding for Oversight and Implementation: The bill directs the transfer of $20,000,000 in fiscal year 2026 from the Federal Hospital Insurance Trust Fund to the Centers for Medicare & Medicaid Services Program Management Account. This allocation is meant to support the enhancement of oversight mechanisms outlined in the bill, such as the increased survey frequency for certain hospice programs.
Funding for Provision of Explanation of Benefits: Additionally, the bill provides for the transfer of $10,000,000 in fiscal year 2026 from the same trust fund to support the creation and distribution of explanation of benefits notices for individuals electing hospice care. This aims to improve transparency and patient knowledge regarding hospice services under Medicare.
Technical Expert Panel Participation and Audit Costs: The bill allocates $10,000,000 for each of the fiscal years 2026, 2031, and 2036 for conducting audits on hospice programs and setting up technical expert panels to review these audits. This allocation underscores the intent to maintain financial accountability and monitor billing practices among hospice providers.
Relation to Identified Issues
These financial provisions address several issues identified in the bill analysis, but they also have potential implications:
Administrative Burden: The financial allocations for oversight and information dissemination are substantial. However, there is concern that the increased administrative and financial burden associated with frequent surveys and program revalidations may disproportionately affect smaller hospice providers. This could lead to potential financial strain on these smaller entities, which might lack the resources to comply easily with the intensified scrutiny and bureaucratic requirements.
Resource Allocation and Efficiency: The significant amounts earmarked for oversight indicate priorities set on eliminating waste, fraud, and ensuring high-quality care. However, these allocations also raise concerns about the overall efficiency and practicality of implementing such extensive oversight measures without concrete evidence of their efficacy. With resource-intensive reporting requirements and audits, there is a criticism that these funds might be better spent directly on care improvements rather than administrative processes.
Potential Impacts on Provider Operations: The imposition of up to $1,000,000 in civil monetary penalties for non-compliance with ownership change notifications highlights a focus on strict regulatory compliance. However, this could pose risks for hospice providers undergoing routine restructuring or mergers, potentially creating instances of undue financial hardship for entities adhering to business-as-usual practices.
Overall Fund Utilization: While the Secretary has discretionary power in using these funds, there is a potential risk of funds being used inefficiently without comprehensive oversight or cost-control measures. The discretion given for forming technical panels and carrying out audits without stringent checks might result in less-than-optimal use of financial resources, as highlighted by one of the issues identified.
In summary, while the financial allocations within the bill aim to improve oversight, transparency, and service quality in hospice care under Medicare, the execution and real-world impact of these financial directives warrant careful consideration to avoid placing undue burdens on smaller providers and ensure efficient utilization of public resources.
Issues
The mandatory temporary moratorium on the enrollment of new hospice programs (Section 2) could limit access to hospice care in underserved areas, potentially affecting individuals in need of terminal care and creating disparities in health service distribution.
The provision to allow the Secretary of Health and Human Services significant discretion in lifting the moratorium or granting waivers (Section 2) may lead to inconsistent regulatory application and favoritism, raising concerns about transparency and equity.
The criteria for determining 'aberrant billing patterns' and subsequent medical reviews (Sections 2 and 3) lack clarity, which may result in arbitrary administrative decisions and increased scrutiny from hospice care providers over billing practices.
The complexity of the language used in payment reforms, such as per diem and per visit payment rates (Section 3), could lead to administrative errors and requires extensive cross-referencing, affecting understanding among stakeholders and potentially leading to incorrect implementation.
The allowance for telehealth in recertifications under certain conditions (Section 2) may not ensure adequate assessments of patients' eligibility for hospice care, potentially affecting the quality of patient evaluations.
The increased administrative burden due to frequent surveys and revalidations for hospice programs (Sections 2 and 3) could disproportionately impact smaller hospice providers, posing a financial strain and potentially affecting operations.
The report requirements by the Comptroller General and associated burdens (Section 2) could be resource-intensive and may lack actionable outcomes, raising concerns about the efficiency and practicality of these mandates.
The significant financial penalties for failing to meet advanced notice of ownership changes (Section 2) might impose heavy burdens on hospice programs, particularly in the event of routine corporate restructuring or mergers.
The discretion given to the Secretary in determining technical expert panels and audits without clear cost-control measures (Section 3) could lead to inefficient utilization of funds without comprehensive regulatory oversight or justification.
Sections
Sections are presented as they are annotated in the original legislative text. Any missing headers, numbers, or non-consecutive order is due to the original text.
1. Short title Read Opens in new tab
Summary AI
The first section of the law states that it can be referred to as the “Hospice Care Accountability, Reform, and Enforcement Act of 2024” or simply the “Hospice CARE Act of 2024.”
2. Ensuring the integrity of hospice care furnished under the Medicare program Read Opens in new tab
Summary AI
The section outlines various measures to protect the integrity of hospice care under the Medicare program, including temporary halts on new hospice enrollments, increased oversight and survey frequency for certain hospice programs, penalties for failure to report quality data, and stricter requirements on ownership changes. It also mandates transparency in ownership information, modifies requirements for physician certifications and recertifications, enhances medical reviews, and ensures that hospice patients receive detailed information regarding their care and any non-covered services.
Money References
- “(C) REMOVAL FROM LIST.—The Secretary shall remove a hospice program included in the list established under subparagraph (A)— “(i) if— “(I) such program has been subject to 2 surveys under this subsection while included on such list; and “(II) neither such survey resulted in such program being cited for a deficiency for failure to comply with a condition of participation relating to quality of care; or “(ii) if such program is placed in the special focus program established under subsection (b).”; and (4) in paragraph (6), as so redesignated, by striking “each fiscal year (beginning with fiscal year 2022)” and inserting “each of fiscal years 2022 through 2025, and of $15,000,000 for fiscal year 2026 and for each subsequent fiscal year,”. (d) Prohibition on payment for failure To meet quality data reporting requirements.—Section 1814(i)(5) of the Social Security Act (42 U.S.C. 1395f(i)(5)) is amended— (1) in subparagraph (A)— (A) in the header, by striking “Reduction in update for”; (B) in clause (i)— (i) in the header, by striking “In general” and inserting “Fiscal years 2014 through 2026”; (ii) by inserting “through fiscal year 2026” after “each subsequent fiscal year”; and (iii) by adding at the end the following new sentence: “The application of the preceding sentence may result in the market basket percentage increase under paragraph (1)(C)(ii)(VII) or paragraph (1)(C)(iii), as applicable, being less than 0.0 for a fiscal year, and may result in payment rates under this subsection for a fiscal year being less than such payment rates for the preceding fiscal year.”; and (C) by amending clause (ii) to read as follows: “(ii) SUBSEQUENT FISCAL YEARS.—For purposes of fiscal year 2027 and each subsequent fiscal year, no payment may be made under this title to a hospice program that does not submit data to the Secretary in accordance with subparagraph (C) with respect to such fiscal year.”; and (2) in subparagraph (B), by striking “subparagraph (A)” and inserting “subparagraph (A)(i)”. (e) Ensuring independence of physician certifications of terminal illness.—Section 1814(a)(7)(A)(i) of the Social Security Act (42 U.S.C. 1395f(a)(7)(A)(i)) is amended— (1) in subclause (I), by inserting “or, with respect to certifications under this clause occurring on or after October 1, 2026, in the case such individual fails to designate such an attending physician (or in the case such attending physician is employed by the hospice program at which such individual will receive such care or otherwise has a significant ownership interest in, or a significant financial relationship with, such program (as determined by the Secretary)), by a physician, physician assistant, or nurse practitioner that does not have such a significant ownership interest in, or such a significant financial relationship with, such program (as determined by the Secretary)” before “, and”; and (2) in the matter following subclause (II), by striking “physician’s” and inserting “physician’s, physician assistant’s, nurse practitioner’s,”. (f) Allowing additional providers To certify terminal illness.
- (2) ENFORCEMENT.— “(A) IN GENERAL.—In the case that the Secretary determines that a hospice program has violated paragraph (1), the Secretary may— “(i) impose a civil monetary penalty in an amount not to exceed $1,000,000 per violation; and “(ii) if determined appropriate by the Secretary, terminate such program’s enrollment under this title. “(B) PROCEDURES.—The provisions of section 1128A (other than subsections (a) and (b) of such section) shall apply to a civil monetary penalty imposed under subparagraph (A) in the same manner as such provisions apply to a penalty or proceeding under such section.”.
- . (3) FUNDING.—The Secretary of Health and Human Services shall provide for the transfer, from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i) to the Centers for Medicare & Medicaid Services Program Management Account, of $20,000,000 for fiscal year 2026, to remain available until expended, for purposes of carrying out the amendments made by this subsection.
- — (1) IN GENERAL.—Section 1806 of the Social Security Act (42 U.S.C. 1395b–7) is amended by adding at the end the following new subsection: “(d) Provision of explanation of benefits upon hospice election.—The Secretary shall furnish to each individual who makes an election described in section 1812(d)(1), not later than 15 days after such individual makes such election, a notice that— “(1) specifies— “(A) the effective date of such election; “(B) the hospice program that will be furnishing hospice care to such individual; “(C) the telephone number and address of such program; “(D) the physician, physician assistant, or nurse practitioner who made the certification described in section 1814(a)(7)(A)(i)(I) with respect to such individual; “(E) the toll-free telephone number of the medicare administrative contractor responsible for processing claims for such care; “(2) informs such individual of the waiver of rights described in section 1812(d)(2)(A); “(3) includes a statement which indicates that, because errors do occur and because Medicare waste, fraud, and abuse is a significant problem, such individual should carefully check the individual’s hospice election information and if such individual suspects Medicare waste, fraud, or abuse with respect to the provision of such care, the individual should contact the toll-free phone number 1–800–MEDICARE and a toll-free phone number maintained by the Inspector General of the Department of Health and Human Services for the receipt of complaints and information about waste, fraud, and abuse in the provision or billing of services under this title; and “(4) includes any other information determined appropriate by the Secretary.”. (2) FUNDING.—The Secretary of Health and Human Services shall provide for the transfer from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i) to the Centers for Medicare & Medicaid Services Program Management Account of $10,000,000 for fiscal year 2026, to remain available until expended, for purposes of carrying out the amendment made by paragraph (1). (3) EFFECTIVE DATE.—The amendment made by paragraph (1) shall apply to individuals making elections described in section 1812(d)(1) of the Social Security Act (42 U.S.C. 1395d(d)(1)) on or after the date that is 1 year after the date of the enactment of this Act.
3. Payment reforms for hospice care furnished under the Medicare program Read Opens in new tab
Summary AI
This part of the bill outlines reforms to the way Medicare pays for hospice care, aiming to adjust payment rates based on the costs of care and other factors. It includes new rules for payment calculations, specifies how "routine home care" and other types of hospice services should be reimbursed, and introduces new requirements for care plans and services offered at different facilities, with specific timelines for when these changes take effect.
Money References
- “(V) The Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund established under section 1817 to the Centers for Medicare & Medicaid Services Program Management Account, of $10,000,000 for each of fiscal years 2026, 2031, and 2036, to remain available until expended, for purposes of carrying out this clause.”. (2) OUTLIER PAYMENTS.—Section 1814(i) of the Social Security Act (42 U.S.C. 1395f(i)) is amended— (A) by redesignating paragraph (7) as paragraph (8); and (B) by inserting after paragraph (6) the following new paragraph: “(7)(A) Subject to subparagraph (B), with respect to routine home care furnished during a fiscal year beginning on or after October 1, 2031, the Secretary may, if determined appropriate by the Secretary, provide an additional payment for types of such care (such as specified hospice care (as defined in paragraph (1)(C)(ix))) specified by the Secretary to account for unusual variations in the type or amount of such routine home care.