In response to the unnatural growth in hospices in several states, four major provider groups jointly urged Congress and the Centers for Medicare & Medicaid Services Thursday to enact legislative and regulatory changes to strengthen the integrity of the program. These changes include a “targeted moratorium on new hospices, especially in regions with explosive hospice growth” and revoking Medicare enrollment against non-operational hospices.
The National Association for Home Care & Hospice, LeadingAge, the National Hospice and Palliative Care Organization and the National Partnership for Healthcare and Hospice Innovation sent lawmakers and regulators a list of more than three dozen recommendations. Among them:
- Limit enrollment of new providers with a targeted moratorium on new hospices, especially in regions with explosive hospice growth.
- Enforce against non-operational hospices by revoking Medicare enrollment and increasing site visits.
- Develop hospice “red flag” criteria that identify application triggers related to specific areas of concern that would prompt a CMS investigation before certification approval.
- Require surveyors to confirm the ability of hospices to provide all four levels of care.
- Add hospice administrator and patient care manager qualifications to Medicare hospice Conditions of Participation (CoPs).
The recommendations come after a year-long effort by the groups to assess options for improving hospice care and over concerns of oversaturation of hospices and accusations of fraud in certain U.S. markets. In particular, California, Arizona, Nevada and Texas have seen rapid growth in the number of hospices.
“NAHC believes strongly that improved hospice program integrity will benefit patients, families, providers and the Medicare program, and that it is an essential element in ensuring quality of care,” NAHC President William Dombi said in a statement.
Washington, DC, must act now on bad hospice actors as many of the nation’s 72 million aging baby boomers may require hospice in the future, LeadingAge President and CEO Katie Smith Sloan said in a statement.
“Bad care and true fraud in this valuable benefit are intolerable. It’s time to take action,” Sloan said. “America’s population is aging, and high-quality services are needed now more than ever before. Reform must promote high-quality care, including the right services in the right quantity, and eliminate opportunity for misdeeds.”
The hospice industry has been under fire in recent months by government watchdogs and the media. Last week, the Government Accountability Office called for tougher regulations that would require hospices to report abuse and neglect the same way nursing homes do. Meanwhile, a ProPublica report late last year accused some for-profit hospice providers of fraud by recruiting patients who should not have qualified for hospice care. Provider groups condemned the report, calling it inaccurate.
This is a developing story. Please check back for updates.