NAHC announces its legislative agenda

If initiatives pass, home care could reap rewards

When the Hospice Association of America announced its 2000 Legislative Blueprint for Action, included in it were the association’s top 10 legislative issues.

They in turn were reviewed and approved by the Washington, DC-based National Association for Home Care (NAHC) Government Affairs Committee.

Clearly these initiatives are geared to the hospice industry, however, should they pass, there is a foreseeable benefit to home care, especially in terms of wages.

According to NAHC, the top 10 hospice legislative priorities for 2000 are:

1. Ensure access to medications necessary for pain control.

Congress should oppose any legislation that would directly or indirectly set limits or prohibit physicians from prescribing adequate and appropriate controlled substances for the management of pain related to terminal illness.

2. Include in-home respite care in the Medicare hospice benefit.

Congress should establish a separate payment category in the Medicare hospice benefit for in-home respite care. Provision of in-home respite services would provide family relief and support while the patient remains at home.

3. Oppose decreasing hospice reimbursement for dually eligible patients residing in nursing facilities.

Congress should oppose any legislation that would decrease the reimbursement for hospice services for dually eligible patients residing in nursing facilities without appropriate data collection and analysis supporting 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.

4. Amend hospice core service requirements to permit the delivery of specialized nursing treatments under contract.

Congress should amend § 1861 (dd)(2)(A)(ii)(I) of 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.

5. Oppose implementation of penalties for erroneous certification of terminal illness.

Congress should oppose imposition of civil monetary penalties upon physicians for false certification of eligibility for hospice care.

6. Protect hospices from the impact of sequential billing.

Congress should require the Health Care Financing Administration to process and pay all clean claims as submitted regardless of whether previous claims have been processed, and pay interest on claims that are not processed in a timely manner.

7. Clarify the definition of hospice multiple sites.

Congress should clarify the definition of hospice multiple-site service area, establishing a uniform, reasonable, and up-to-date policy that focuses on the ability to provide quality care and positive outcomes rather than imposing arbitrary and ineffective time and/or distance requirements. This definition should recognize the technological advances (communication tools that allow instantaneous information exchange by fax, telephone, beeper, cell phone, etc.) and provide efficient and effective ways to "distance-manage" offices.

8. Provide sufficient home care and hospice payments so that agencies can provide appropriate wages and benefits to clinical staff.

Congress should provide that federal programs (Medicare and Medicaid) that finance home care and hospice services adjust reimbursement to allow for appropriate wage and benefit levels of all clinical staff.

9. Require demonstration projects to study special services and financing of end-of-life care.

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 settings. Demonstration projects that study the special care needs of adults and children and evaluate the practices and procedures that will improve patient outcomes and resource utilization for end-of-life care would contribute valuable information about care needs and costs at the end of life.

10. Ensure the portability of advance directives.

Congress should support legislation that ensures the portability of an individual’s advance directive between health care 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 health care facility.