Literature Review

CMS submits 75,000 pages to federal court to justify nursing home staffing mandate McKnights Long-Term Care News; by Kimberly Marselas; 9/15/24 The Department of Health and Human Services filed more than 75,000 pages of rule-making records with a federal court Friday, beginning its formal defense of its controversial nursing home staffing mandate. The submission of the administrative record is the first significant advance in the case since the American Health Care Association brought its challenge to the minimum staffing standard in late May. The Texas Health Care Association, three Texas providers and LeadingAge are also part of the case. In another development, District Court for the Northern District of Texas Judge Matthew Kacsmaryk on Sept. 10 agreed to fold in a separate federal challenge against the staffing mandate filed by the state of Texas. He noted that the two cases “share common questions of law or fact, consist of similar parties, the same claims, and [have] the same relief sought.”

Telehealth groups urge feds to extend virtual prescribing flexibilities  Healthcare IT News; by Mike Miliard; 9/11/24 With just four months to go until the scheduled expiration of Drug Enforcement Administration flexibilities on virtual prescribing of controlled substances, a long list of hundreds of healthcare stakeholders is calling on Congress and the White House to extend them before "countless patients [are] abandoned, left without lifesaving clinically appropriate care." Led by the American Telemedicine Association and its ATA Action arm, more than 330 disparate organizations have signed on to an effort urging federal officials to extend pandemic-era allowances for virtual prescribing that "have been a lifeline for countless individuals across the country, ensuring uninterrupted access to essential mental health care, substance use treatment, end-of-life care, and many other crucial treatments during a time when in-person visits were impossible or unsafe."

Hospice care standards are important. Congress must be careful tinkering with them. NorthJersey.com, Special to the USA TODAY Network; by Patrick Maron; 8/28/24... As hospice care grows, real attention needs to be paid to the differences between nonprofit and for-profit centers.  [A] staggering  73%  of hospice programs today are for-profit and are driven by financial motives, ... Rep. Earl Blumenauer, D-Oregon, is drafting legislation that, if enacted, would represent the most significant reforms to date for hospice payment and oversight. Though Blumenauer’s bill, the Hospice Care Accountability, Reform, and Enforcement — or Hospice CARE — Act, is still in development, key provisions will likely include a new payment mechanism for high-acuity palliative services, changes to the per-diem payment process and actions to improve quality and combat fraud. The bill would also implement a temporary, national moratorium on the enrollment of new hospices into Medicare, to help stem the tide of fraudulent activities ... However, there are significant challenges for nonprofit freestanding inpatient hospice facilities like Villa Marie Claire in Saddle River. Most important, the proposed five-year moratorium on enrolling new hospice programs into Medicare could limit our ability to expand services, straining resources of the Villa ... What’s more, the legislation mandates more frequent inspections and enhanced oversight, which could lead to operational stress and higher costs. [Click on the title's link to continue reading.]

Blumenthal & Barragán introduce bicameral legislation to improve end-of-life carePress release; 8/1/24U.S. Senator Richard Blumenthal (D-CT) and U.S. Representative Nanette Barragán (D-CA) today introduced the Compassionate Care Act, legislation to promote advance care planning and end-of-life care. Many Americans do not have plans in place in the event they experience severe illness. In order to help patients access the care they need and that is right for them, the Compassionate Care Act provides critical resources to educate patients and providers, develop core end-of-life quality measures, and expand access to advance care planning via telehealth.

How the Hospice CARE Act could change respite services Hospice News; by Jim Parker; 8/1/24 The Hospice Care Accountability, Reform, and Enforcement (Hospice CARE) Act, if enacted, would make changes to the ways hospices provide respite care. Rep. Earl Blumenauer (D-Oregon) is in the process of drafting the bill that would represent the most significant reforms to date for hospice payment and oversight. The legislation is currently in a discussion draft phase, which has been circulated among the nation’s major industry trade associations and their members for feedback. ... “There’s evidence that people who take advantage of hospice care delivered properly, actually have a higher quality of life. Oftentimes, they live longer,” Blumenauer said at Elevate. “This is an opportunity to do something in this Congress that is concrete, specific, that will save money and improve the quality of care for some of our most vulnerable people.”

Senators introduce bipartisan bill to expand zccess to senior care program [PACE] FCFreePress.com; by News Desk - Health News; 7/25/24 [Thursday, 7/25/24,] U.S. Senators Bob Casey (D-PA) and Mike Braun (R-IN), leaders of the U.S. Senate Special Committee on Aging, introduced the bipartisan PACE Anytime Act. This legislative move seeks to broaden the accessibility of the Program of All-Inclusive Care for the Elderly (PACE) which serves thousands of lower-income seniors and individuals with disabilities by offering comprehensive, integrated care. ... Under current regulations, eligible individuals can only enroll in PACE programs at the beginning of each month. The PACE Anytime Act proposes to remove this restriction, allowing for enrollment at any time during the month, thereby making the program more accessible. 

New proposed federal legislation takes aim at concerns regarding perceived “looting” of health care systems by private equity investors JDSupra - Epstein Becker Green; by Melissa Jampol, Enrique Miranda, Kathleen Premo; 7/26/24On June 11, 2024, U.S. Senators Ed Markey and Elizabeth Warren from Massachusetts, introduced proposed legislation titled The Corporate Crimes Against Health Care Act (“CCAHCA”), aimed at addressing a perceived “looting” of health care systems by for profit private equity investors. According to Sen. Warren, the bill was introduced to “root out corporate greed and private equity abuse in the health care system,” “prevent exploitative private equity practices,” and to specifically ensure that actions such as “looting” do not happen again by addressing trigger events and targeting real estate investment trusts. ... Finally, the CCAHCA would require health care entities, including, but not limited to:  ... a hospice program, a home health agency, ... to publicly report to the Secretary of Health and Human Services on an annual basis: (i) transactions entered into ... [Click on the title's link to continue reading.]

[NJ] Governor Murphy signs "Louisa Carman Medical Debt Relief Act” Official Site of the State of New Jersey; 7/22/24 Governor Phil Murphy today signed the Louisa Carman Medical Debt Relief Act which will help New Jersey families avoid falling into medical debt and protect individuals from predatory medical debt collectors. The Louisa Carman Medical Debt Relief Act is named in honor of a member of the Governor’s Office who helped craft the proposal before tragically passing away in a car accident on New Year’s Day at the age of 25. Joined by Louisa’s family and advocates, the Governor signed the bill, advancing his Administration’s efforts to make New Jersey’s health care system more accessible and more affordable for more people.

County Commissioners question providing nonprofits with funding Times Union Online, Kosciusko County, IN; by David L. Slone; 7/16/24 The future of Kosciusko County government providing funding to local nonprofit organizations is uncertain. Tuesday, after some discussion on the appropriateness of the county giving taxpayer dollars to nonprofits, the Kosciusko County Commissioners approved recommending to the County Council that seven nonprofits receive the same amount of funds in 2025 as they did in 2024. [Among the organizations listed is] Stillwater Hospice, $50,000. ... [Commissioner Cary] Groninger said the county council would have the final say on the nonprofit funding. ... [Commissioner Brad] Jackson said the decision was a tough one and they didn’t just want to stop providing funding without giving the nonprofits notice. 

Hospice CARES Act would update medical reviews, seek to reduce audits Hospice News; by Jim Parker; 7/12/24 The forthcoming Hospice Care Accountability, Reform and Enforcement (Hospice CARE) Act from U.S. Rep. Earl Blumenaur (D-Oregon), if enacted, would implement a number of changes to medical review processes. ... Though the bill language is still in development, it will likely contain proposed updates to payment mechanisms for high-acuity palliative services, changes to the per-diem payment process and actions to improve quality and combat fraud. The bill would also implement a temporary, national moratorium on the enrollment of new hospices into Medicare, to help stem the tide of fraudulent activities among recently established providers concentrated primarily in California, Arizona, Texas and Nevada. ... Among the anticipated provisions of the bill would be an item requiring the U.S. Centers for Medicare & Medicaid Services (CMS) to use documentation in a patient’s medical record as supporting material. The documentation would include the reasons that an attending physician certified a patient for hospice and establish a six-month terminal prognosis.

Lawmakers say CMS should ban Medicare Advantage’s use of AI to deny care McKnights Long-Term Care News; by Josh Henreckson; 6/26/24 The Centers for Medicare & Medicaid Services should consider banning artificial intelligence from being used to deny Medicare Advantage coverage pending a “systematic review,” a group of 49 congressional leaders is urging. ...  Skilled nursing providers have been sounding the alarm for years on Medicare Advantage coverage access, especially when informed by AI and other algorithms. Sector leaders have frequently noted that these methods can deny or prematurely end coverage for patients who need it to afford necessary long-term care. Providers and consumer advocates both spoke out in favor of the lawmakers’ letter this week. “LeadingAge’s nonprofit and mission driven members … have firsthand experience of Medicare Advantage (MA) plans’ inappropriate use of prior authorization to deny, shorten and limit MA enrollees’ access to medically necessary Medicare benefits,” wrote Katie Smith Sloan, president and CEO of LeadingAge. ... “Implementation by [the] Centers for Medicare and Medicaid Services (CMS), which we fully support, would ensure MA plans fulfill their obligation to provide enrollees equitable access to Medicare services.”

How the Supreme Court’s Chevron Decision could help stop home health cuts Home Health Care News; by Andrew Donlan; 6/28/24 On Friday, the U.S. Supreme Court upended the Chevron doctrine precedent. For home health industry purposes, that means a potentially weakened Centers for Medicare & Medicaid Services (CMS) moving forward. The news comes just two days after the home health proposed payment rule was released, which included significant cuts for the third straight year. Broadly, moving away from the Chevron precedent – usually known as the Chevron doctrine – will mean less regulatory power for government agencies. Government agencies often take their own interpretations of certain laws and statutes, and then act upon those interpretations. ... The National Association for Home Care & Hospice (NAHC) already filed a lawsuit against the U.S. Department of Health & Human Services (HHS) and CMS over rate cuts in 2023. “In our own analysis, we believe that providers of home health have been underpaid as it relates to budget neutrality,” NAHC President William A. Dombi said when the lawsuit was filed. “At minimum, we would expect to see the rate cuts from 2023, that were permanent readjustments to the base rate, and the one proposed for 2024, along with the temporary adjustments … to go away. The end product of that is that we would have a stable system to deliver home health services to Medicare beneficiaries.”

Delaware legislature passes Medical-Aid-in-Dying law CBS WBOC, DOver, DE; by Sean Curtis; 6/25/24 The Delaware State Senate is sending House Bill 140, or the End-of-Life Options Law, to Governor John Carney’s desk after passing it Tuesday [6/25/24]. ... Medical aid in dying would only be available to adult Delawareans diagnosed with an incurable disease or illness who have been given a prognosis of six months or less to live. The prognosis must come from at least two medical professionals, according to lawmakers. Advanced age, disability, mental illness, or chronic health conditions would not qualify a person, under the law. Those seeking medical aid in dying under HB 140 would need to demonstrate an ability to understand and grasp the consequences of their decision, as determined by a licensed psychiatrist or psychologist. ... It will now head to the Governor’s Office for Carney’s signature before becoming law, unless Carney chooses to veto the legislation.