House Energy and Commerce Committee Examines Medicaid Legislation, 80-20 Moratorium
NAHC
On Tuesday, April 30th, the Health subcommittee of the House Energy and Commerce Committee held a hearing on Legislative Proposals to Increase Medicaid Access and Improve Program Integrity. The hearing’s sole witness was Daniel Tsai, the director of Medicaid within the Centers for Medicare and Medicaid Services (CMS), who provided perspective on the Administration’s priorities regarding Medicaid coverage, eligibility, and access to services.
Importantly, the hearing included legislation that would prohibit CMS from enacting the 80-20 passthrough provision within the Medicaid Access rule among the 19 bills examined during the session. During the session, lawmakers showed the stark partisan divide over the Access rule, with Republicans consistently advocating to repeal 80-20 and Democrats lining up to support the policy.
Opening statements from Committee Chair Rodgers (R-WA) and Guthrie (R-KY) criticized the proposal and expressed concerns about the unintended consequences of the provision. In contrast, Committee ranking member Pallone (D-NJ) and subcommittee ranking member Eshoo (D-CA) supported the passthrough requirement, praising the Administration for implementing the policy.
Many of the questions posed by lawmakers to Mr. Tsai dealt directly with the 80-20 requirement, including inquiries on the basis for the provision, what CMS expected the outcomes to be, and requests for more information about the data and analysis used to establish and justify the threshold. Reps. Dunn (R-FL) and Harshbarger (R-TN) specifically probed for information regarding CMS’ understanding and calculations regarding how they define the HCBS provide operating margin and CMS’ concerns about provider expenditures that prompted the regulation.
Notably, while Director Tsai repeatedly stressed that they utilized data and analysis to inform their decisions, no specific information was provided regarding the data sources, analyses, and outcomes.
Bills discussed during the hearing also included a number of other important pieces of legislation that would improve Medicaid, including proposals that would:
- Make Money Follows the Person and Spousal Impoverishment Protections permanent;
- Remove the Age 65 limit on the Ticket to Work Medicaid Buy-in for workers with disabilities;
- Remove the requirement that an individual need an institutional level of care in order to qualify for home and community-based services under a Medicaid waiver; and
- Remove the requirement for states to collect assets from the estate of older adults who received Medicaid services.
Information about the Hearing including text of the legislation and a recording of the proceedings is available online at: https://energycommerce.house.gov/events/health-subcommittee-hearing-legislative-proposals-to-increase-medicaid-access-and-improve-program-integrity. |
CMS Revises Hospice Certifying Physician Enrollment Requirement Implementation Guidance
NHPCO
On June 6, 2024, in response to concerns raised by NHPCO and NAHC, CMS retracted its guidance indicating that any individual who elects to receive hospice services in a subsequent hospice election would need to be certified as if entering hospice in the initial benefit period. As we shared in our member alert yesterday, this guidance, published in a Hospice Certifying Enrollment Questions and Answers (Q & A) Document, contradicted Section 1814(a)(7) of the Social Security Act (SSA) and regulations at 42 C.F.R. § 418.22(c)(2). The SSA and regulations indicate that the attending physician must only certify a patient’s terminal illness for the initial hospice Medicare benefit period; and that only one physician, not both the attending and hospice physician, must provide this certification for subsequent benefit periods. See our statement in response.
Prior Guidance:
Q: Does this certification requirement also apply regarding beneficiaries who had been previously discharged during a benefit period and are being certified for hospice care again to begin in a new benefit period?
A: Yes. Any individual who revoked, or was previously discharged from, the hospice benefit, and then reelects to receive the hospice benefit in the next available benefit period, will need to be certified as if entering the program in an initial benefit period---and the certifying physician(s) must be enrolled or opted-out as specified above.
Revised Guidance:
Q: Does this new requirement change who can certify for hospice services?
A: Except for the new enrollment or opt-out requirement, nothing is changing under 42 CFR § 418.22 regarding who may certify the patient’s terminal illness.
This retraction ensures alignment with existing law and regulations, alleviating confusion among hospice providers, Medicare Administrative Contractors (MACs), and electronic medical record (EMR) vendors. View the updated Q&A Document.
Next Steps:
While we appreciate CMS's immediate response to our concerns, NHPCO and NAHC will continue to engage with the agency on outstanding issues associated with the implementation of the physician enrollment requirement. To support our members’ efforts to navigate through remaining inconsistencies in certifying physician enrollment regulatory guidance, NHPCO and NAHC developed a Physician Enrollment Requirement FAQ and Guidance tool.
As we shared in our prior alert, NHPCO and NAHC are also hosting a joint webinar on June 18 to review the current implementation status of implementation, share what we know, insights on initial challenges and best practices, and address common questions.
Navigating the Hospice Certifying Physician Enrollment Requirements Latest Updates and Q&A
June 18, 2024
1:30 – 2:30 p.m. MT
Register |
Senate May Have the Votes to Scrap Biden’s Nursing Home Staffing Mandate
Axios | By Vistoria Knight and Peter Sullivan
A resolution aimed at overturning President Biden's controversial nursing home staffing minimums has a chance of passing the Senate.
Why it matters: The vote would show the resistance to the first-of-its-kind standard and reveal a rift among Democrats, even though Biden would almost certainly veto the measure.
Nursing homes already are challenging the mandate in federal court.
Between the lines: Sens. Jon Tester (D-Mont.) and Joe Manchin (I-W. Va.) are sponsoring the Congressional Review Act resolution released last week. They and all of the chamber's Republicans could deliver the simple majority of votes required for passage.
The standard would, among other things, require 33 minutes of care per patient per day from a registered nurse, which backers argue would make nursing homes safer and ensure seniors are not left in need for hours.
"It would be a shame if lawmakers move forward with trying to stop this life-saving rule in its tracks," an AARP spokesperson said about the resolution.
But nursing home operators and their allies say it's impossible to meet because of persistent health workforce shortages, especially in rural areas, and would force some facilities to close.
What they're saying: Tester, who's up for reelection in a red state, has been outspoken against the mandate, citing its potential impact on rural facilities, and sought to distance himself from Biden.
"At a time when nursing homes across Montana are struggling with workforce shortage issues, it makes no sense for unelected bureaucrats in the Biden administration to hand down a one-size-fits-all policy that would force these critical facilities to shutter their doors," Tester said in a statement…
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Using Palliative Sedation At End of Life
By Barbara Karnes
Palliative sedation is a term used by hospice, palliative care, and medical professionals to describe giving large doses of sleep-inducing medications to induce unconsciousness. It is a pain management technique used when all other pain management options have been unsuccessful. It is not routinely used. I would even say it is seldom used.
The National Cancer Institute defines palliative sedation as: “The use of special drugs called sedatives to relieve extreme suffering by making a patient calm, unaware, or unconscious. This may be done for patients who have symptoms that cannot be controlled with other treatments. Palliative sedation may be used in patients who are near the end of life to make them more comfortable. It is not meant to shorten life or cause death.”
I found many other definitions (I love the internet), but this one was the easiest to understand and said what the others were saying but in much less technical detail.
When the terminal illness, the disease progression, has been a pain-filled experience and all comfort management options have been unsuccessful, then sleep is our friend. Sleep, created by regulated, supervised medications, is a compassionate alternative to uncontrollable suffering.
Covid taught us the benefit of “putting a person to sleep” as their body heals. That same technique can also be used as end of life approaches. Not to accelerate the end of life process, but to provide comfort until death comes. |
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