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Government Funding Bill Extends Telehealth Flexibilities, Averts Cap Cut

(Alexandria, VA) Congress has released the text of the Consolidated Appropriations Act, 2023, an omnibus funding package that will fund the government through Fiscal Year 2023. As NHPCO advised its members in a Member Alert this morning, the legislation contains measures that will affect hospices positively and negatively. We expect the legislation to pass and be signed into law later this week.  

Key developments in this legislation include the following.  

    • Telehealth extension: The legislation extends hospice telehealth flexibilities through the end of 2024, which were initially enacted as part of the CARES Act in 2020. This allows hospice patients and providers to continue to use telehealth for low touch, face-to-face visits prior to recertification for the hospice benefit. Patients will also be able to continue to participate in telehealth visits from home. 
    • Continued slowdown of hospice caps: The legislation extends the cap calculation methodology implemented by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. For years that measure has slowed the growth of the hospice aggregate cap, reducing the total amount a hospice can be reimbursed for care provided to patients, as compared to the rates set prior to the IMPACT Act. The FY23 omnibus extends that IMPACT Act aggregate cap methodology by another year to 2032, meaning that for the next decade many hospices will have to do more with less to continue providing patient care. 
    • Cap cut avoided: Beyond extension of the IMPACT Act methodology, there was some consideration to MedPAC’s recommendation to outright decrease the hospice aggregate cap by 20 percent. That cut was averted, protecting hospice patients and providers.
    • Expanded definition of the IDT: The legislation will allow hospices, starting in 2024, to use marriage and family therapists (MFTs) and mental health counselors (MHCs) as part of the hospice interdisciplinary team. There is no requirement for hospices to use MFTs or MHCs and a social worker is still required if needed under a patient’s plan of care.
    • Focus on Grief and Bereavement: Noting that more Americans are experiencing grief due to COVID-19 losses, the bill designates $1,000,000 for assessing the feasibility of developing consensus-based quality standards for high-quality bereavement and grief care. It also directs the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) to collaborate with other health officials to evaluate and report on the scope of need for high-quality bereavement and grief services, including a focus on the role of hospices in community services. 

“This package is a mixed bag for hospices. On the one hand, NHPCO members have been actively advocating for telehealth extension, against a 20 percent cap cut, and for national approaches to supporting grief and bereavement services. 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,” said NHPCO COO and interim CEO, Ben Marcantonio “Thank you to everyone who has reached out to their elected officials on these issues. On the other hand, Congress has extended the slowdown of the growth of the hospice aggregate cap, even though the evidence shows that the seven percent reductions already implemented through the IMPACT Act have limited access to hospice care among patients with Alzheimer disease and other dementias.” 

Marcantonio continued, “Avoiding an across-the-board cap cut, while facing continued slowdown of cap growth is like two steps forward, one step back. Forty years after the creation of the Medicare Hospice Benefit, in bleak economic times, Congress has decided to put to the next ten years of hospice care at risk by continuing to recklessly use hospice as an ATM.”