Arizona Hospice and Palliative Care Organization

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Talking Points – CAP issues as prompted by NY Times article

 

To:       NHPCO Members

From:   NHPCO Public Policy Team

Date:    November 27, 2007

 

In today's New York Times, an article "In Hospice Care, Longer Lives Mean Money Lost" appeared on the front page. Reporter Kevin Sack was writing about the hospice CAP, an issue that providers in the industry well know is complex and can be misunderstood by those not familiar with the many regulatory issues concerned.

NHPCO would like to offer members some talking points about the CAP to help inform discussion

 

Key Message:
There is NO limit to the amount of hospice care an eligible Medicare beneficiary can receive from hospice.  Additionally, NHPCO has long argued that hospices that are admitting eligible patients in accordance with federal guidelines should not be required, under the cap, to return payments to the government.

 

  • There is not a limit on the amount of hospice care an individual can receive as long as the patient qualifies under the Medicare Hospice Benefit.
o   Medicare recertifies patients for two 3-month periods and then re-certifies patients for unlimited number of 2-month periods.  As long as the patient qualifies for care under the MHB, care should be paid for by Medicare.

 

  • To be reimbursed under Medicare, hospice providers must make sure that all patients are eligible for coverage and are appropriate admissions for hospice.
o   CMS does not prohibit a hospice provider from providing care to a patient; however, in order to be reimbursed by Medicare, they must meet admission guidelines as outlined by CMS.

 

  • Hospice reimbursement systems are not necessarily perfect.  One reason CMS seeks re-payment from hospices is when a provider hits what is known as the aggregate "cap."  This can even result when patients have been admitted appropriately. 
o   It is estimated that 15% of providers who have claimed processed by Palmetto have hit the Medicare Cap.

o   Providers in some states have "cap" issues in a disproportionate rate when looked at national averages. 

o   Reimbursement system that more appropriately reflects today's complex patient mix has been proposed by organizations like the National Hospice and Palliative Care Organization and its affiliate the Alliance for Care at the End of Life. 

 

  • The Centers for Medicare and Medicaid Services is committed to ensuring that all beneficiaries who are coping with a life-limiting illness will have access to the care and services provided by hospice. 
o   More than 83% of hospice care in the U.S. is paid for under the Medicare Hospice Benefit (2006). 

o   More than 871,249 Medicare beneficiaries received care in 2005; with more than 1.2 million total patients served from all payor sources. 

 

 

Hospice programs exceeding cap limits does not necessarily have a single cause, rather, it is usually driven by a number of complicated and interrelated issues that deserve careful consideration in attempting to address the problem. NHPCO as well as the Alliance for Care at the End of Life are actively engaged in seeking reasonable and responsible solutions with key policy makers in Washington.  

 

Hospice programs serving Eligible patients receiving appropriate care should not be penalized for providing high quality end-of-life care.

 



President's Budget Proposes Extensive Cuts to Home Health and Hospice

Impact Summary by State

President Bush submitted his Fiscal Year 2008 budget to Congress on February 5,2007 proposing to save more than $100 billion in five years from cuts in Medicare and Medicaid spending. Most of the Medicare savings would be achieved by freezing or reducing the inflation updates for Medicare providers.

 

Bush's budget would cut Medicare home health spending by $9.68 billion by freezing home health payments over five years (FY08-FY12) and instituting a permanent cut in the home health inflation update of 0.65 percent thereafter. It would cut hospice payments by $1.140 billion through a permanent reduction of 0.65 percent to the hospice update.

 

The president also proposes to cut all Medicare provider payments by .4 percent whenever the Medicare trustees issue two Medicare trust fund "warnings" and Congress fails to respond to the warning by reducing Medicare spending from general revenues below a 45 percent threshold established by the Medicare Modernization Act (MMA) (NAHC Report 5/11/06).

 

Following the takeover of Congress by the Democrats in the last election, the president's proposed Medicare cuts may not be well received on Capitol Hill. NAHC will launch another grassroots campaign, much like last year when the home care and hospice community succeeded in persuading Congress to reject the president's proposed cuts in home health and hospice.

 

NAHC is preparing a state-by-state and district-by-district analysis of the impact of the president's proposal on home health and hospice for use in its grassroots campaign.