Sen. Whitehouse Introduces Legislation Focused on Improving Care for Medicare Patients with Advanced Illnesses
July 1, 2016 11:00 AM
On June 23, 2016, Senator Sheldon Whitehouse (D-RI) introduced legislation that would improve care for Medicare beneficiaries with advanced illnesses. Sen. Whitehouse announced the legislation at a hearing of the Special Committee on Aging, chaired by Sen. Susan Collins (R-ME). The Removing Barriers to Person-Centered Care Act (S. 3096) is relevant to both home health and hospice, and it contains priority provisions strongly supported by the National Association for Home Care & Hospice (NAHC). The legislation would set up a pilot program for which the Centers for Medicare & Medicaid Services (CMS) would waive a number of current regulations: for example, eliminating the homebound requirement for Medicare patients to receive home health care services; allowing non-physician practitioners to certify patients for home health and hospice services and sign plans of care; and allowing Medicare patients to receive hospice care and curative treatment at the same time.
Sen. Whitehouse said the legislation would promote better coordination between health care providers and place greater emphasis on the preferences of Medicare beneficiaries with advanced illnesses. “Too many Rhode Island Medicare patients battling difficult illnesses are struggling to get the right care at the right time,” said Sen. Whitehouse. “We need to break down the barriers between patients and the care they need. Because so many of the rules and incentives in our health care system are tied to the payment structure, we should design payment systems that support new models of coordinated care that are focused on human beings and not some rule or regulation.”
Approximately 90 million Americans are living with advanced illness. Projections estimate that number is expected to more than double in the next 25 years.
Following is a summary of the legislation released by Sen. Whitehouse’s office:
The CMS-administered pilot program would be made up of 20 “advanced care collaboratives” of affiliated health care providers and community-based social service organizations. Collaboratives would receive a planning grant to assess the needs of the population of patients it would serve; to purchase or upgrade health information technology to facilitate better coordination of care between providers; and to support education and training on documenting and communicating beneficiary treatment preferences and goals.
Once planning is complete, collaboratives would enter a three-year payment agreement with Medicare to provide coordinated, high-quality care for their target patient population. Under the terms of the pilot program, CMS would waive regulations to promote innovative care for patients with advanced illness. Waivers would be granted to:
Allow Medicare patients to receive hospice care and curative treatment at the same time. CMS’s current regulations force patients to choose one or the other for their terminal illness.
Allow patients to receive Medicare coverage in a skilled nursing home without a consecutive three-day inpatient hospital stay. Under current Medicare rules, patients are often charged for skilled nursing care after they leave an inpatient hospital stay because they were hospitalized for observation rather than admitted to the hospital.
Allow Medicare patients to receive home health services without the requirement that they be homebound. Under current rules, a patient’s condition must have progressed such that there “exists a normal inability to leave home,” denying these services to those who are seriously ill but still mobile.
Allow nurse practitioners to sign home health and hospice care plans and certify patients for services. Right now, only doctors can do so, even though nurse practitioners are often the ones overseeing the patient’s health care. This forms another barrier for patients seeking these services, especially in underserved and rural areas.
The bill would also create two new coverage options under Medicare’s hospice benefit, which is available for terminally-ill Medicare beneficiaries with a life prognosis of six months. Those options would:
Allow Medicare coverage of room and board at inpatient facilities for individuals who elect and are certified for routine hospice care, but whose home environment is not safe for home-based hospice care. Currently, Medicare does not pay for room and board at nursing facilities for individuals who elect routine-level hospice care. Dying patients whose home environment is not conducive to home-based care often opt to receive rehabilitative services to retain Medicare coverage of facility-based care, leading to patients receiving unnecessary and possibly harmful rehab.
Allow Medicare coverage for short-term, home-based respite care as an alternative to inpatient respite care for individuals who elect and are certified for routine hospice care. Providing patients and their caregivers the option to stay in their home for the receipt of respite care would alleviate the stress of transporting a dying patient to and from an inpatient facility.
Additional information about the legislation is available here. View Sen. Whitehouse’s remarks at the hearing of the Senate Aging Committee here.