Federal Spending Bill Would Extend Hospice Recertification Via Telehealth Through 2024

The omnibus spending bill currently set before Congress includes provisions that would extend the waiver for recertification using telehealth through the end of 2024, among other items pertaining to hospice.

Legislators have released the text of the more than 6,000-page bill that is intended to fund the federal government for Fiscal Year 2023. Congress is working to pass the bill before the end of the week when they will recess for the holidays.

Initially implemented during the COVID-19 public health emergency (PHE), an extension of the recertfication waiver has been high on hospice providers’ wish list.

“Many of the telehealth flexibilities that have helped dramatically improve patient access to care are temporary and limited to the duration of the COVID-19 [public health emergency] — and impact both public health programs and private health coverage …,” a group of 336 health care industry organizations wrote in a letter to congressional leaders earlier this year. “As it stands today, providers must weigh the costs of investing in the technological and clinical infrastructure required to maintain telehealth programs at scale against the possibility that Congress may ultimately decide not to support permanently expanded telehealth coverage.”

Temporary regulatory flexibilities have allowed more extensive telehealth use during the COVID-19 public health emergency. For many hospices, what began as a temporary measure has evolved as an integral part of clinical operations.

Hospices have used telehealth systems to identify and educate clinicians about patient needs, including social determinants of health and the condition of their homes or care environment. Clinicians have also used virtual visits to assess medication or care plans in real time.

Rapid deployment of telemedicine during the PHE also has created “a new pathway” for bringing palliative and hospice care specialists to rural areas, according to authors of a recent report published in the JAMA Health Forum. Additional studies further support the claim that changes to telehealth policy improved access.

If enacted, the bill would also allow hospices to include marriage and family therapists and mental health counselors as part of the interdisciplinary teams, and extended a methodology for slowing increases of aggregate payment cap through 2031. This practice was introduced for the years 2016 through 2025 via the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 for years 2016. Congress previously extended this process to 2030.

The hospice components of this bill are a “mixed bag,” according to National Hospice and Palliative Care Organization (NHPCO) COO and interim CEO Ben Marcantonio.

“On the one hand, NHPCO members have been actively advocating for telehealth extension, against a 20% cap cut, and for national approaches to supporting grief and bereavement services,” Marcantonio said in a statement “Those provisions are wins for patients, families, and communities across the country, as is the inclusion of marriage and family therapists and mental health counselors as part of the hospice interdisciplinary team.”

The extension of the payment cap process was less favorable, according to Marcantonio.

Recent research in JAMA Health Forum has indicated that the IMPACT Act may be associated with reductions in hospice utilization among people suffering from dementia-related illnesses.

The National Association for Home Care & Hospice (NAHC) hailed the inclusion of telehealth recertification but also pledged to oppose the extension of the hospice cap rules.

“There are some significant victories for NAHC advocacy and this for our members and for all hospice providers and patients,” Tom Threlkeld, director of communications for NAHC, told Hospice News. “But we didn’t get everything we wanted, and it makes it clear that there’s plenty more work for us to do in what remains is this year and 2023.”