1. Federal Update Membership Meeting October 17, 2018
Home Care, Hospice & Palliative Care Alliance of NH

2. H.R. 6, The Support for Patients and Communities Act
Bipartisan opioid legislation
Overwhelming passage in House and Senate
Awaiting President Trump’s signature
Allows hospice personnel to dispose of controlled substances in certain situations
Creates a GAO study of hospice drug management
Sen. Hassan was the lead Democrat on S.2659, embedded in H.R.6

3. Hospice Disposal
An employee of a qualified hospice program will be permitted to handle for the purpose of onsite disposal controlled substances for use by a hospice patient after the patient has died or in cases where medication has expired
If the employee is the physician of the hospice patient, he/she may dispose of medications in cases where the plan of care has changed and the patient no longer needs the medication
Qualified hospice is the same as the CoP.
Disposal must be documented in the clinical record
“Hospice employees” is a physician, PA, RN or other licensed to perform medical or nursing care, acting in the scope of employment, and who has completed training about disposal of controlled substances.

4. Hospice Study
Government Accountability Office (GAO) will study and report to Congress within 18 months
Requirements to and challenges of hospice programs with regard to the management and disposal of controlled substances in the home of an individual.
The GAO will make recommendations for legislative or administrative actions.

5. S.3545, Untitled
Introduced by Sen. Collins (R-ME), Stabenow (D-MI) and Nelson (D-FL)
Prevents CMS from making assumptions about provider behavior in a new Medicare payment model.
Stops over $1 billion in cuts
Requires CMS to make rate adjustments only after home health behavioral changes actually occur
Allows Medicare Advantage plans and certain innovative care delivery models to waive “homebound” status when the plan or payment model determines that care in the home would improve patient outcomes or reduce spending on patient care.
Limited to MA plans and models that assume financial risk for overuse of services
Takes effect in January 2020
We will be asking NH’s Senators to co-sponsor this bill

6. S.445/H.R.1825,home health planning improvement act
Allows Nurse Practitioners and Physician Assistants to certify a patients eligibility for the Medicare home health benefit
Enables ARNPs and PAs to certify F2F encounters and oversee care plans
Improves access to care for people in NH, especially rural areas
Co-sponsored by Senators Shaheen & Hassan and Reps. Kuster and Shea-Porter
Will likely need to be embedded in omnibus health legislation in order to pass

7. H.R. 1676/S.693, Palliative Care and Hospice Education and training Act
Increases the number of palliative care faculty in medical and nursing schools
Promotes education and research in palliative care and hospice
Supports development of faculty and academic palliative medicine
Co-sponsored by Reps. Kuster and Shea-Porter
Passed the House in July
We have asked both Senators to co-sponsor S.693

8. H.R.1828/S.445, Rural Access to Hospice Act
Allows rural health clinics and federally- qualified health centers to bill Medicare for hospice attending physician services
Currently, patients with PCPs who are employed by an RHC or FQHC must give up their PCP to obtain hospice services
Senator Shaheen is the lead Democrat on S.445
The entire NH Congressional delegation has co-sponsored these bills

9. S.1334/H.R.2797, Patient Choice and Quality Care act
Creates a Medicare advanced illness care and management model
Provides access to advance care planning tools
Promotes portability of advance directives
Develops quality measure for advanced illness, palliative care and end of life care
We have asked our NH Delegation to co- sponsor these bills

10. Regulatory issues
Final proposal on the 2019 Home Health Payment Update and Patient-Driven Groupings Model (PDGM) reform should be released this month.
NH is ranked 20th in estimated impact of PDGM.
NH: +1.5%.
Highest: VI, +28.6%
Lowest: ID, -11.8%
Accurate coding will be critical!

11. Targeted probe & EducatE
“CMS loves Targeted Probe & Educate!”
TPE Round 1 in Region JK: (as of mid-September)
283 agencies in TPE
83 completed
1/3 on to Round 2
New TPEs
Home care – episodes with visits (40 claims)
Hospice
1) hospice services in non-home setting;
2) LOS over 180 days for non-cancer diagnoses
20 claims each
Call Gina if you have any issues with TPE process