HAA’s legislative agenda for 2000
HAA’s legislative agenda for 2000
Pain initiatives top the list of goals
The Hospice Association of America (HAA) finalized its 2000 Legislative Blueprint for Action in February. It includes a list of its top 10 legislative issues. HAA president Karen Woods says the plan was developed with input from HAA’s members and reviewed by the National Association for Home Care’s Government Affairs Committee.
She says the 10 items were selected from a list of nearly 30 areas the association initially identified. Here is a rundown:
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," the HAA says.
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 says. "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."
A stay of respite
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," says the HAA.
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, notes 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."
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," the HAA states. "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."
Woods notes 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’ Office of Inspector General about the possibility of fraud. "That has led to some suggestion to eliminate that benefit," she says. "We simply want a study to be completed before any change is made."
4. 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," the HAA states.
Woods notes 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 explains. "But if claims are reviewed, all billing subsequent to that should not be stopped, because that can have a devastating financial impact."
Clarification, please
5. 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," the HAA says. "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."
6. 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 contends there are already severe shortages of home health aides, which can have a major impact on how care is delivered.
She says 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 explains. "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."
7. 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," the HAA says. "Demonstration projects that study the special care needs of adult 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."
8. 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," the HAA says.
9. 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.
10. 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 say could inhibit doctors from authorizing appropriate hospice care out of fear of financial penalty.
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