In August 2009, NAHA member hospice Haven Hospice won its court challenge to the hospice cap regulation. Federal Judge George Wu ruled the hospice cap regulation invalid, set aside CMS’ 2006 cap demand to Haven Hospice and ordered HHS to either return funds previously paid by Haven Hospice or apply those funds (including interest already paid) to a new demand. Since then, more than ten other federal judges, in suits brought on behalf of individual hospices, have held the regulation invalid and precluded further application to those hospices.
But, the Haven Hospice and other decisions do nothing for other hospices that receive demand letters. Hospices that receive repayment demands should appeal such demands (within 180 days). By doing so, hospices may reduce their liability and recover prior interest payments to HHS.
For more information contact Brian Daucher at (714) 424-2843 or at bdaucher@sheppardmullin.com. Read More→
Who Fact-Checked MedPAC Staff’s Hospice Analysis?
By · CommentsMedPAC staff’s shoddy hospice analysis is misleading MedPAC Commissioners and healthcare policy; it also misses reform opportunities that would improve patient access and save money. Read More→
Independent research data shows that the unlawful 1983 hospice cap regulation disproportionately harms already underserved non-cancer and minorty patients. And so will any regulation that arbitrarily limits the proportional allocation of cap allowances to less than a full allocation across all of each patient’s days of service. Any such regulation would fail to meet Congress’ express requirement to match allowances with revenues, would understate allowances and overstate repayment demands, and would make non-cancer and minority patients second class hospice citizens.
We respectfully disagree with CMS’ argument that increasing the time period limitation by one or two years will solve the issue, because “99.98% of hospice beneficiaries who died in 2007 were admitted to hospice in either 2006 or 2007.” CMS should focus not upon which beneficiaries die in a given year, but rather upon which beneficiaries continue to live. NAHA commissioned independent researchers at Avalere to examine 100% of the 3.5 million Medicare beneficiaries who elected the hospice benefit between 1/1/2003 and 12/31/2007, and asked them how many of those hospice patients were still alive years later, at 12/31/2007. Avalere’s findings were: 2% of patients admitted in 2003, 3% of those admitted in 2004, 5% of those admitted in 2005, 9% of those admitted in 2006 and 23% of those admitted in 2007 were alive at 12/31/2007. And, non-cancer patients’ and minority patients’ “still alive percentages” were significantly higher than average, suggesting that limiting cap allocations will have a disproportionate impact on these already-underserved populations.
See summary of independent research data commissioned by NAHA and complied by Avalere: Percentage of Hospice Patients Admitted 2003-2007 Still Alive at 12/31/2007, by Diagnosis, by Race.
Write Your Own Email to Secretary Sebelius
By · CommentsAdd your voice of support to NAHA Board’s letter to Secretary Sebelius requesting that she, and HHS, “Do the Right Thing: Stop Using the Invalid Hospice Cap Regulation”.
How to send an email to Secretary Sebelius in a few simple steps:
First, adopt the right attitude… remember Secretary Sebelius did not draft the hospice cap regulation BUT she can decide to not use it now that it has been invalidated (twice). So, be firm, direct, open, and very polite. Any lack of civility in your email will, at a minimum, diminish its value and, potentially, damage the overall cause.
Second, compose your own letter in your own words. “Cookie-cutter” or “cut and paste” letters will be much less effective than a sincerely worded, personal letter. The following text template is provided for your reference as to what types of information you should include. Please use the full closing information (name, address, and phone number). You will not be contacted but it is important that your email communicate that you are a “real” person rather than some computer generated mailing campaign. Read More→
Letter to Secretary Sebelius at HHS: Do the Right Thing…
By · CommentsLetter to Secretary Sebelius at HHS: Do the Right Thing, Stop Using the Invalid Hospice Cap Regulation!
September 15, 2009
Kathleen Sebelius Secretary, Health and Human ServicesDear Ms. Sebelius:
Re: Hospice Cap Regulation
The National Alliance for Hospice Access (NAHA) represents more than 500 independent hospices in 32 states that serve tens of thousands of patients every year, primarily in rural, minority or economically disadvantaged communities. As you know, NAHA is supporting hospice reform legislation (HR 3454) as well as hospice cap compromise efforts that would improve patient choice, reform the hospice cap, reduce HHS’ administrative burden, and reduce Medicare’s costs by $10 billion to $20 billion over the next ten years. We hope you will consider supporting these reforms…
Read the full text of the NAHA_Board_Letter_to_Sebelius_15Sep09
Federal Court Judge Puts Hold on His Own Nationwide Injunction; Will HHS Resume Use of Invalid Hospice Cap Regulation?
On August 20, 2009, Federal district court judge George Wu entered final judgment against the Department of Health and Human Services (read Final Federal Court Judgment Remand) in favor of NAHA member hospice Los Angeles Haven Hospice on its challenge to the hospice cap regulation. In addition to provisions affecting only Haven Hospice, Judge Wu’s decision included a nationwide injunction precluding HHS from using the invalid regulation to calculate any future cap demands. Read More→
Follow HR 3454 Medicare Hospice Reform and Savings Act of 2009, To amend title XVIII of the Social Security Act to reform payments and coverage for hospice care, on OpenCongress.org
“H.R. 3454: Medicare Hospice Reform and Savings Act of 2009“
You can follow the progress of our newly introduced legislation, H.R. 3454 Medicare Hospice Reform and Savings Act of 2009, To amend title XVIII of the Social Security Act to reform payments and coverage for hospice care, on GovTrack.US or on the NAHA site.
NAHA Press Release: August 26, 2009
Judge Tells HHS to Stop Using Invalid Hospice Cap Regulation
On Friday, August 21, 2009, Federal District Court Judge George Wu entered final judgment against the Department of Health and Human Services in favor of Los Angeles Haven Hospice on its challenge to Medicare’s hospice cap regulation. Haven Hospice had challenged the regulation used to calculate the hospice cap on the grounds that it did not meet the clear requirements of the governing hospice cap statute. The decision demonstrates that HHS has been miscalculating the cap, and harming hospices, by failing to give proportional allowances that could decrease the cap liability of any hospice that has experienced periods of long average length of stay.
Read the full text of the NAHA Press Release
Read the Federal Court Judgment in favor of NAHA member Haven Hospice
