NAHA -- National Alliance for Hospice Access

Welcome to NAHA: True Hospice Reform

INDEPENDENT HOSPICES AND THE TERMINALLY ILL PATIENTS WE SERVE NEED YOUR SUPPORT FOR TRUE HOSPICE REFORM LEGISLATION, HR3454 MEDICARE HOSPICE REFORM AND SAVINGS ACT OF 2009

The National Alliance for Hospice Access (NAHA) is a non-profit, grassroots coalition of over 500 hospices, founded to promote true hospice reform, and specifically to address the Hospice Cap Crisis, a regulatory disaster that threatens hospices’ ability to continue to provide quality care to eligible, terminally ill patients.

NAHA members are independent family-owned and community-based hospices that care for tens of thousands of terminally ill seniors annually, largely in rural, minority and economically disadvantaged communities. NAHA is funded by contributions from independent hospices and from individual hospice advocates; our staff are part-time, unpaid volunteers.

NAHA hospices don’t have deep pockets, cannot meet CMS demands to repay money spent years ago caring for eligible, terminally ill seniors, and will not survive without urgent action by Congress.

THE PROBLEM…

Too few of our terminally ill seniors receive a timely hospice choice, and Medicare’s end-of-life care costs are billions of dollars per year higher than they should be. Choice is especially poor in rural and minority communities, and for the 78% of seniors who die from non-cancer causes. Only 7% of our terminally ill seniors receive between 60 and 180 days of hospice care, the range in which quality care and cost-effectiveness best coincide.

And, the Hospice Cap is now devastating hundreds of independent hospices who provide quality, cost-effective end-of-life care to tens of thousands of seniors in underserved rural, minority and economically-disadvantaged communities. Conflicting federal laws and Medicare regulations are forcing hundreds of quality independent hospices into bankruptcy, causing thousands of high-quality jobs to disappear, solely because their eligible patients “live too long.”

1998 federal law promises terminally ill seniors unlimited hospice days

But, the 1982 hospice cap law demands huge retroactive repayments from hospices whose patients “live too long”

Making a bad 1982 law worse, CMS is still using a 1983 regulation that overstates cap repayment demands and has been ruled invalid by ten different federal courts

And, Medicare’s own hospice eligibility criteria are not evidence-based, are seriously flawed and further harm timely hospice choice

THE SOLUTION

NAHA supports hospice reform legislation that will improve patient access, stabilize independent hospices, and save taxpayers billions of dollars.

Introduce evidence-based patient eligibility criteria for hospice care that will improve timely patient choice and save Medicare more than $5 billion over the next 5 years.

Reform the existing, flawed cap with a “pay as you go” savings system that:

more efficiently eliminates any unintended financial incentive for longer patient stays, and generates an additional $1.6 billion in Medicare cost savings over 5 years

dramatically reduces Medicare’s administrative burden, and eliminates delays in realizing the savings, by never paying out money that Medicare will later want repaid

Reallocate per diem reimbursement to better reflect hospice costs for the first and last days of a patient’s hospice stay and repeal the phase-out of the hospice Budget Neutrality Adjustment Factor (BNAF).