LeadingAge National Government News: October 2, 2024

Senator Kevin Cramer (R-ND) voiced his opposition to the federal staffing mandate in a September 24 speech delivered on the floor of the U.S. Senate. He also spoke on the dangers of administrative bureaucracy and the punitive nature of survey fines experienced by long-term care facilities.  

“In May, CMS issued this minimum staffing rule, which requires long-term care facilities to implement new staffing requirements,” said Sen. Cramer. “These are already institutions that are already woefully understaffed because of a lack of workforce. Most burdensome is the new requirement to have a Registered Nurse on site 24 hours a day, seven days a week, rather than the previous eight hours a day, seven days a week. Less than a quarter of North Dakota facilities meet this requirement, and among rural facilities, only 14 percent will meet that mandate.”  

Sen. Cramer has pushed back against the nursing home staffing standard for nearly two years, sending a letter cosigned by 12 bipartisan Senate colleagues to CMS in January 2023. As a member of the Senate Veterans Affairs Committee, Sen. Cramer joined U.S. Senator Angus King (I-ME) in introducing a bill to require the Department of Veterans Affairs to submit a report regarding the proposed rule’s impact on the access of veterans to long-term care. The senators later requested the VA study the potential harmful effects of the staffing rule on LTC facilities. Sen. Cramer also joined U.S. Senator James Lankford (R-OK) in cosponsoring H.J.Res.91, the Congressional Review Act resolution of disapproval to overturn the final rule issued by CMS.  

On September 25, Representatives James Comer (R-KY) and Morgan McGarvey (D-NY) introduced the Health Care Workforce Investment Act (H.R.9812) to encourage states to create healthcare workforce partnerships to address the shortage of nurses, nurse aides, and other healthcare professionals. The legislation would provide grant funding to cover up to 50% of a state’s allocation for healthcare workforce public-private partnerships and scholarship programs. H.R. 9812 is modeled after programs in Kentucky, Louisianna and Florida. To view the text of the bill, click here and to see the summary click here. LeadingAge is assessing the bill. 

Medicare certified hospices will start collecting data on the Hospice Outcomes and Patient Evaluation (HOPE) beginning on October 1, 2025 (FY 2026). Now is the time to start training staff on the key elements of this data collection tool which will now be required for the Hospice Quality Reporting Program (HQRP).   

First, LeadingAge has developed a crosswalk of the new HOPE tool with the sunsetting Hospice Item Set (HIS). This crosswalk looks at which items from the HIS will remain part of the HOPE, which items are new based on the CMS HOPE tool beta test, and which items have been updated based on the beta test. Second, the Centers for Medicare & Medicaid Services produced a 4-minute, animated explainer video for hospice providers on the Hospice Outcomes and Patient Evaluations (HOPE). The video covers the purpose of the HOPE, the timepoints, their data collection timeframes, and introduces the symptom follow-up visit (SFV), if triggered during a HOPE timepoint. 

On September 25, Representative Earl Blumenauer (D-OR) introduced the Hospice CARE Act of 2024. The bill, if enacted, would make the largest changes to the hospice benefit since 1982 when hospice became part of the Medicare program. The bill is a combination of program integrity measures and payment reforms aimed at targeting bad actors in hospice and attempting to ensure that payment incentives are more appropriately aligned with care provision and the needs of beneficiaries. The bill also includes a number of benefit expansions, including payment for high-cost palliative therapies and expanded options for respite care, for which LeadingAge has long advocated. Mr. Blumenauer solicited feedback on the draft of this bill in June; our comments on that draft can be found here. Staff has been clear that they are open to continuing work to refine the legislation.  

• Please be sure to join the LeadingAge Hospice Network on October 8, 1 PM CTT for a discussion with legislative staff on the bill.  

• An article on the payment changes proposed in the bill can be found here; an article on the program integrity provisions will be available in the coming days.  

• Our press statement on the bill can be found here. 

• Please find the bill text here, the bill one pager here, and the section-by-section here. 

Mr. Blumenauer’s statement can be found here. 

Previously, the Centers for Medicare and Medicaid Services (CMS) started requiring that certifying physicians for hospice, including those employed by the hospice and attending physicians, were enrolled in or opted-out of the Medicare program effective May 1, 2024. CMS has updated their instructions for this requirement again to exclude nurse practitioners (NP) and physician assistants (PA) in the claims edit when they are the attending physician for the patient.  

Further, CMS has clarified these professionals in the Medicare Claims Processing Manual, Chapter 11 for hospice. These changes will be implemented on October 7, 2024, for claims submitted on or after October 7, 2024, with dates of service as of June 3, 2024, or later. CMS will check the REF PHYS NPI field and the ATT PHYS NPI field on hospice claims to make sure the certifying physicians, including hospice physicians and hospice attending physicians, are enrolled in or opted out of Medicare. They will subject both physicians, if different, to the ordering and referring denial edits for the initial certification period. If an NP or a PA is serving as the designated attending, CMS will only subject the certifying physician in the REF PHYS NPI field to the ordering and referring denial edits. 

• Affordable Housing Weekly Recap. Here is your weekly Affordable Housing Weekly Recap. 
• Home Health Weekly Recap. Here is your weekly Home Health Weekly Recap. 

• Hospice Weekly Recap. Here is your weekly Hospice Weekly Recap. 

• Life Plan Community Weekly Recap. Here is your weekly LPC Weekly Recap. 

• Medicaid, HCBS, and PACE Weekly Recap. Here is your weekly Medicaid, HCBS, and PACE Weekly Recap. 

• Nursing Home Weekly Recap. Here is your weekly Nursing Home Weekly Recap.
• Workforce Weekly Recap. Here is your weekly Workforce Weekly Recap.