HAA sets 2000 legislative agenda, including a list of top 10 issues

By MATTHEW HAY

HHBR Washington Correspondent

WASHINGTON – The Hospice Association of America (HAA; Washington) last week made final its 2000 Legislative Blueprint for Action, including a list of its top 10 legislative issues. HHA President Karen Woods said the plan was developed with input from HAA’s members and reviewed by the National Association for Home Care’s (NAHC; Washington) Government Affairs Committee.

She said the top 10 items were selected from a list of roughly 30 areas the association initially identified. Here is a rundown of the top 10 items that Woods reviewed with HHBR:

Ensure access to medications necessary for pain control. HAA will urge Congress to oppose any legislation directly or indirectly setting limits or prohibiting physicians from prescribing appropriate substances for pain management

According to Woods, this item flows from controversy about assisted suicide legislation earlier introduced in Oregon and elsewhere that the association feared could have had a chilling effect on doctors providing appropriate medication. "Anything that would deter a physician from providing appropriate medication needs to be looked at carefully," she said. "Pain medication should be provided to terminally ill patients when needed, and physicians should not have to worry about the government accusing them of attempting to provide assistance of suicide."

Include in-home respite care in the Medicare hospice benefit. HAA wants Congress to establish a separate payment category in the Medicare hospice benefit for in-home respite care. Importantly, the provision of in-home respite services would provide family relief and support while the patient remains at home.

The Medicare benefit provides a stay of respite, but that respite has to be offered in an in-patient facility for a patient to qualify, noted Woods. "We are simply asking for a change in the wording of that, that would allow for brief episodes of respite for the caregiver where care could be provided in the patient’s residence instead of a facility," she said.

Oppose decreasing hospice reimbursement for dually eligible patients residing in nursing facilities. HHA will urge Congress to oppose any legislation that would decrease the reimbursement for hospice services for dually eligible patients residing in nursing facilities without first collecting and analyzing data to support such a change. "Legislative changes to this area of hospice reimbursement prior to an in-depth study and analysis will, in effect, deny access to humane compassionate care for bona fide eligible terminally ill residents of nursing facilities," according to HHA.

Woods noted that when Medicaid pays for nursing home room and board, patients can also access their Medicare benefit for hospice services. But she pointed to close scrutiny by the Department of Health and Human Services’ (Washington) Office of Inspector General about the possibility of fraud. "That has led to some suggestion to eliminate that benefit," she said. "We simply want a study to be completed before any change is made."

Protect hospices from the impact of sequential billing. According to HAA, Congress should require the Health Care Financing Administration (Baltimore) to process and pay all clean claims as submitted, regardless of whether previous claims have been processed, and to pay interest on claims that are not processed in a timely manner.

Woods noted that sequential billing proved to be major burden on home health agencies when claims were pending. "We think hospice should bill in chronological order," she explained. "But if claims are reviewed, all billing subsequent to that should not be stopped because that can have a devastating financial impact."

Clarify the definition of multiple hospice sites. The association will urge Congress to clarify the definition of hospice multiple site service areas. HAA says it wants "a uniform, reasonable, and up-to-date policy that focuses on the ability to provide quality care and positive outcomes" rather than "arbitrary and ineffective time and/or distance requirements." It also wants that definition to permit communication through faxes, telephones, and other electronic methods.

Provide sufficient home care and hospice payments so that agencies can provide appropriate wages and benefits to clinical staff. HAA wants Congress to boost reimbursement under Medicare and Medicaid to allow for appropriate wage and benefit levels of all clinical staff for home care and hospice services. Woods said there are already several shortages of home health aides, which can have a major impact on how care is delivered.

She said HAA is looking at the whole issue of rates and how they are established. "Over time, there have been many changes in what is required to pay qualified staff," she explained. "Under current reimbursement systems, that means keeping an eye on payment rates so that you have enough money to provide the care that is required."

Require demonstration projects to study special services and financing of end-of-life care. The association says Congress should enact legislation that would provide for demonstration projects to study special services and financing of end-of-life care, in-home care, and hospice.

Ensure the portability of advance directives. HAA will urge Congress to support legislation that ensures the portability of an individual’s advance directive between healthcare facilities, as well as between states. "An advance directive belongs to an individual and should not be interfered with or interrupted by the laws of any particular state or healthcare facility," according to HAA.

The association also wants congress to amend hospice core service requirements to permit the delivery of specialized nursing treatments under contract. Specifically, the association will urge Congress to amend the Social Security Act by including a provision allowing certain specialized high-tech nursing services to be provided by contract, under the direction and supervision of the hospice as necessary to meet the needs of the hospice patient.

Finally, HHA said Congress should oppose implementation of penalties for erroneous certification of terminal illness. Specifically, it will also urge Congress to oppose the imposition of civil monetary penalties on physicians for false certification of eligibility for hospice care, which Woods said could inhibit doctors from authorizing appropriate hospice care out of fear of financial penalty.