Hospice Priorities and Positions

1. Ensure access to medications necessary for pain control
   Congress should oppose any legislation that would directly or indirectly set limits or prohibit physicians from prescribing adequate and appropriate controlled substances for the management of pain related to terminal illness.
   
   
2. Include in-home respite care in the Medicare hospice benefit
   Congress should establish a separate payment category in the Medicare hospice benefit for in-home respite care. Provision of in-home respite services would provide family relief and support while the patient remains at home.
   
   
3. Oppose decreasing hospice reimbursement for dually eligible patients residing in nursing facilities
   Congress should oppose any legislation that would decrease the reimbursement for hospice services for dually eligible patients residing in nursing facilities without appropriate data collection and analysis supporting such a change. Legislative changes to this area of hospice reimbursement prior to an in-depth study and analysis will, in effect, deny access to humane compassionate care for bona fide eligible terminally ill residents of nursing facilities.
   
   
4. Amend hospice core service requirements to permit the delivery of specialized nursing treatments under contract
   Congress should amend § 1861 (dd)(2)(A)(ii)(I) of the Social Security Act by including a provision allowing certain specialized high-tech nursing services to be provided by contract, under the direction and supervision of the hospice as necessary to meet the needs of the hospice patient.
   
   
5. Oppose implementation of penalties for erroneous certification of terminal illness
   Congress should oppose imposition of civil monetary penalties upon physicians for false certification of eligibility for hospice care.
   
   
6. Protect hospices from the impact of sequential billing
   Congress should require the Health Care Financing Administration (HCFA) to process and pay all clean claims as submitted regardless of whether previous claims have been processed, and pay interest on claims that are not processed in a timely manner.
   
   
7. Clarify the definition of hospice multiple sites
   Congress should clarify the definition of hospice multiple site service area, establishing a uniform, reasonable, and up-to-date policy that focuses on the ability to provide quality care and positive outcomes rather than imposing arbitrary and ineffective time and/or distance requirements. This definition should recognize the technological advances (communication tools that allow instantaneous information exchange by fax, telephone, beeper, cell phone, etc.) provide efficient and effective ways to "distance-manage" offices.
   
   
8. Provide sufficient home care and hospice payments so that agencies can provide appropriate wages and benefits to clinical staff
   Congress should provide that federal programs (Medicare/Medicaid) that finance home care and hospice services adjust reimbursement to allow for appropriate wage and benefit levels of all clinical staff
   
   
9. Require demonstration projects to study special services and financing of end-of-life care
   Congress should enact legislation that would provide for demonstration projects to study special services and financing of end-of-life care in home care and hospice settings. Demonstration projects that study the special care needs of adult and children and evaluate the practices and procedures that will improve patient outcomes and resource utilization for end-of life care would contribute valuable information about care needs and costs at the end of life
   
   
10. Ensure the portability of advance directives
    Congress should support legislation that ensures the portability of an individual's advance directive between health care facilities as well as between states. An advance directive belongs to an individual and should not be interfered with or interrupted by the laws of any particular state or health care facility.
    
    

HAA has set the following as the top 10 regulatory items for 2000:

1. Encourage the Publication of Proposed Hospice Conditions of Participation (CoP) by the End of 2000
   HCFA should publish the proposed hospice CoP in the Federal Register by the end of 2000 The current CoP are dated, cumbersome and inadequate for today's health care delivery system. It is inappropriate at a time when other Medicare providers are able to update their operations consistent with current practices that hospice providers can only rely on the occasional reinterpretation of outdated CoP.
   
   
2. Ensure Timely Update of Local Medial Review Policies for Hospice
   HCFA should assure that an annual review of all hospice LMRPs is conducted. Revision of the policies should be based on available research and other pertinent findings relevant to the determination of a prognosis of six months or less.
   
   
3. Ensure Access to Drugs Necessary for Pain Control
   HCFA and the FDA should declare inadequate pain management a national public health issue with goals to develop guidelines and educational material that promote effective use of drugs to control pain; and avoid drug enforcement agency actions that would discourage or prohibit physicians from prescribing adequate and appropriate controlled substances for the management of pain related to terminal illnesses.
   
   
4. Modify Hospice Regulations for Inpatient Respite Care
   HCFA should remove the 24 Registered Nurse staffing requirement from the hospice Conditions of Participation for Nursing Facility and Skilled Nursing Facility in-patient respite care.
   
   
5. Abolish Payment Delays Caused by Sequential Billing Policy for Hospice
   HCFA should continue to require hospices to submit claims in chronological order but process and pay all clean claims as submitted, regardless of whether previous claims have been processed. Pay interest on claims that are not processed in a timely manner.
   
   
6. Study Hospice Reimbursement for Dually Eligible Patients Residing in Nursing Facilities
   HCFA should use the hospice cost report as a mechanism to collect and analyze data related to hospice services provided to dually eligible patients residing in nursing homes prior to any actions that would reduce or eliminate these payments.
   
   
7. Establish Hospice Multiple Location and Service Area Requirements that Reflect Quality Measures
   HCFA should discontinue the limitation of multiple hospice locations based on mileage and travel time and enforce current regulations related to quality, administrative control and supervision. HCFA, when making changes to reimbursement appeals rules, must ensure that providers have full access to the systems for review of improper reimbursement determinations.
   
   
8. Oppose Efforts to Require Physician Certification Forms to Include a False Claims Warning
   HCFA should refrain from including a warning statement concerning penalties for false claims on physician certification and recertification forms for terminal illness. Encourage the use of interdisciplinary clinical judgement and appropriate documentation.
   
   
9. Establish Referral Standards and Discharge Planning Regulations that Ensure Patient Choice and Equal Advantage to All Providers
   HCFA should work with the industry to establish referral standards and/or discharge planning regulations for all participating providers and suppliers to ensure that patients have freedom of choice in selection of qualified home health and hospice providers.
   
   
10. Increase Training for Home Health and Hospice Surveyors
    HCFA should provide required surveyor training for all surveyors; based on an established curriculum with specific learning objectives; include information on Medicare coverage of services; ensures consistent interpretation and application of the regulations. Surveyors for the Medicare home health and hospice benefit should have full knowledge of the provisions and requirements of these benefits to avoid inappropriate requirements of hospice and home health providers and ensure the highest quality of care for patients.
    
    

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