To: All Members of the Home Care & Hospice Community
From: Val J. Halamandaris, President, National Association for Home Care & Hospice
Re: Victory on Hospice
Date: July 18, 2014
CMS has issued a new memorandum moderating their regulation on “Part D Payment for Drugs for Beneficiaries Enrolled in Hospice.” The new directive limits prior authorization by hospices to four classes of drugs that were the subject of a report by the HHS Inspector General (IG). These drugs, which are nearly always covered under the Medicare hospice benefit, include analgesics, antinauseants, laxatives, and antianxiety medications.
“This action by CMS will bring marked relief to hospice patients and their providers who have been dealing with the previous policy under which all drugs processed through Part D for hospice patients were subject to prior authorization,” said Andrea Devoti, NAHC chairman of the board of directors.
The IG report charged that hospices were not absorbing their fair share of drugs under the hospice episodic payment system and accused them of improperly passing these costs on to Medicare Part D. The result was a broad-gauge prior authorization requirement designed to limit access to Part D.
Our chairman, Andrea Devoti, wrote to CMS Administrator Marilyn Tavenner, protesting that this guidance would be burdensome to providers, cause confusion, and force patients into a limbo of not knowing whether they were eligible for drug coverage once admitted to hospice. Joanne Cunningham, chairman of the Forum of State Associations, and the members of the Forum sent their own strong letter. All of the state associations joined us in educating their members of Congress about problems with the guidance. Finally, we convinced Senator John D. Rockefeller (D-WV) and Pat Roberts (R-KS) to support us by sending a letter signed by 75 members of the U.S. Senate. All things considered we made a very compelling case.
In closing, I want to thank you all for your help in achieving this victory for hospice. I also want to thank you for helping us win the fight to bring reason to the “face to face” regulation. We appreciate your support with the lawsuits that we have pending, and if you are not a member of NAHC, now is good time to join. Remember, in unity there is strength.