Dome of U.S. Capitol, where the bills have been proposed

Home care providers will focus on the negative impacts of the workforce shortage and Medicare home health payment cuts when they converse with lawmakers during the National Association for Home Care & Hospice’s Advocacy Day next week in Washington, DC.

“Workforce is the top priority that transcends all the various programs,” Bill Dombi, president of NAHC, said Thursday during a webinar about the fly-in day. Several advocacy leaders from NAHC joined him on the webinar sponsored by MissionCare Collective, parent company of myCNAjobs.

Providers from across the home care spectrum will descend on the nation’s capital on Tuesday for the first in-person advocacy day since 2019, the year before the pandemic hit. NAHC is expecting more than 100 providers to attend in person and several times that to be participating virtually. 

Besides workforce, Dombi talked about NAHC’s 2023 focus on lobbying for a temporary suspension in Patient-Driven Groupings Model (PDGM) rate cuts.

“By far, that’s the top priority,” he said Thursday.

A permanent PDGM payment cut of 3.925%, or $635 million, went into effect on Jan. 1. Temporary clawback payment reductions, which may total at least $3 billion, may take effect as soon as 2024.

Next week, home care providers also will push lawmakers to pass the recently reintroduced Better Care, Better Jobs Act, said Calvin McDaniel, NAHC’s director of government affairs for home health. The legislation, which would increase the Federal Medical Assistance Percentage by 10% and require all states to cover caregiver services, represents key Medicaid caregiver legislation.

It is “the biggest, most comprehensive package there is for the workforce right now,” he said.  

Hospice providers will bring their own topics to lawmaker visits early next week, explained Davis Baird, NAHC’s director of government affairs for hospice. Among these will be the need for targeted program integrity and oversight tools for program.

“We want to make ensure it’s not so easy for bad-intentioned individuals to get into the program,” he said, adding, “It’s kind of unfortunate this is one of our priority goals this year.”

He pointed out that there is data indicating large-scale hospice fraud and exploitation. Several states are seeing rapid growth rates in licenses and certifications that is disproportionate to the level of need for hospice care. Other worrisome trends include many hospices clustered in one location. He cited one example of single building containing 120 hospices. While the fraud started in California, it has migrated to states including Texas and Arizona.

“It appears to be spreading,” he said. “We want to stop it before it gets too far.”

NAHC, along with LeadingAge and the National Hospice and Palliative Care Organization, earlier this year sent a list of 34 recommendations to the Centers for Medicare & Medicaid Services to improve the program. The recommendations include a targeted moratorium on new hospices and the development of “red flag” criteria for noncompliant hospices.

Hospice providers also will press lawmakers next week on the value of hospice, as indicated by a study released this week showing that hospice saved Medicare $3.5 billion in 2019, according to Baird. The study is an “arrow in our quiver,” Baird said.