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.