NAHC/HAA Opposes MedPAC Payment and Care Recommendations
January 21, 2014 09:58 AM
At its January meeting held last week, the Medicare Payment Advisory Commission (MedPAC) approved recommendations that direct Congress to include hospice care under the Medicare Advantage (MA) benefit package effective 2016 and impose a zero update for Medicare hospice payment rates for fiscal year (FY) 2015. The National Association for Home Care & Hospice (NAHC) and its affiliated Hospice Association of America (HAA) oppose these recommendations and will advocate against their implementation by Congress.
Historically hospice has been “carved out” from coverage under Medicare’s private plans. MedPAC is seeking inclusion of hospice under MA based on concerns that the current carveout of hospice from MA fragments financial responsibility and accountability for care, results in complex coverage rules for MA enrollees, and makes MA plans’ financial responsibility for end-of-life care uneven across their enrollees. “We understand MedPAC’s rationale that inclusion of hospice under MA may create greater symmetry in coverage between traditional Medicare and Medicare Advantage, but we worry that this change will seriously limit the most important health care provider choice of a beneficiary’s life,” said NAHC President Val J. Halamandaris. “While MedPAC’s recommendation suggests that MA plans would be required to cover the hospice benefit as defined by current law, our experience with home health under MA plans indicates that the plans will second guess care decisions made by hospice clinical teams and could place preauthorization or other limitations on services. In addition, MA plans would have the freedom to impose additional cost-sharing requirements on terminally ill patients for their hospice care.”
NAHC is also deeply concerned about MedPAC’s proposed freeze to hospice payment rates. ''MedPAC has calculated hospice financial margins at about 7.8 percent,” Halamandaris pointed out, “a figure that does not take into account costs related to volunteer, bereavement, and other nonreimbursable services, or the impact of the 2 percent sequester. Under current law, hospice payment updates for the foreseeable future will be flat or, more likely, negative. Meanwhile, hospices are reeling from a growing number of costly new regulatory obligations, and they fear the impact of an impending payment system overhaul. We believe these proposed changes will have a negative impact on the integrity of the Medicare hospice benefit and access to it. We strongly urge Congress to reject them.”