Participate in Action to Protect Home Care and Hospice

Home Care, Hospice Community Urged To 1) Participate in “Virtual Lobby Day” and 2) Ramp Up Grassroots Advocacy over Election Recess

Members of Congress will be leaving this Friday for an election recess with much left on their plate. Before they leave town NAHC is urging home care and hospice advocates to contact Congressional offices in Washington this Thursday, September 20, in a “virtual lobby day.” Once the Congressional election recess begins next week there will be many additional opportunities for home care and hospice grassroots action back in the state and districts.

When Congress returns after the election it must address a number of contentious issues — either in the short time before the end of the year or early next year. These issues include further efforts to reduce the deficit and find offsets for the cost of fixing the flawed Medicare physician payment formula . Congress will also be considering proposals to avoid an across the board “sequestration” cut in spending that includes a 2 percent cut in Medicare provider payments.

The Medicare Payment Advisory Commission, the Congressional Budget Office, and the Bowles-Simpson Deficit Reduction Plan  have recommended home health and hospice payment cuts and copays to fund deficit reduction and/or to offset the cost of the physician payment fix. The home care and hospice community will need to ramp up its efforts to protect the home health and hospice benefits from payment cuts and copays.

Virtual Lobby Day

Call and/or send your members of Congress a message this Thursday urging “no home care and hospice cuts or copays.” When calling, ask to speak to the staffer who handles health care issues.  You may obtain contact information for your Senators and Representative here:  Contact Your Elected Officials. For talking points on copays, go here; for payment cuts, go here. For hospice, go here and here.

To send an email, go to the NAHC Legislative Action Network. For home health, click here; for hospice, click here and here.

Home care and hospice advocates may also wish to raise other important issues, such as:

  • providing a fairer, more transparent process for evaluating case mix changes (The Home Health Care Access Protection Act (S.659; H.R.6059));
  • reforming the home health face-to-face physician encounter requirement;
  • reforming the hospice face-to-face requirement and establishing a hospice payment demonstration program (Hospice Evaluation and Legitimate Payment Act (S.722/H.R.3506);
  • allowing nurse practitioners and physician assistants to sign home health plans of care (The Home Health Care Planning Improvement Act (S.227; H.R.2267));
  • providing incentives for telehomecare (The Fostering Independence through Technology Act (S.501));
  • preserving federal funding for Medicaid;
  • preserving the companionship services exemption from overtime under the Fair Labor Standards Act.

Sample letters and talking points for these issues are on the NAHC Legislative Action Network website.

Grassroots Advocacy over Election Recess

During the election recess, NAHC is urging its members and their friends, families, patients and co-workers to speak out as loudly and forcefully as possible.

Specific questions directed to those who are running for Congress on where they stand on home care and hospice issues can be an effective advocacy tool. You may pose questions to candidates at their town hall meetings or election rallies; by email, fax, Twitter, Facebook or Postal Service; in face-to-face meetings with them or their staff, or on pre-arranged home visits.

The following are some suggested questions on current home care and hospice issues.

  1. Some are suggesting the imposition of a Medicare home health copay for purposes of deficit reduction and/or offsetting the cost of fixing the flawed Medicare physician payment formula. There is evidence that a home health copay would fall most heavily on the oldest, sickest, poorest seniors; shift seniors to more costly hospital or nursing home settings; and increase Medicare and Medicaid costs. A Medicare home health copay was repealed in 1972 because of the burden it placed on seniors, collection costs, and the services it shifted to more costly settings. Would you oppose the imposition of a Medicare home health copay?
  2. Since 2009, when Medicare spent $17 billion on home health care, the Medicare home health benefit has been cut $77 billion over ten years through a combination of legislative and regulatory payment cuts. As a result of these payment cuts nearly 50 percent of Medicare participating agencies will be under water in 2012 – that is, paid less than their costs by Medicare. Would you oppose additional cuts in home health care payments? Would you oppose the 2 percent sequestration cut in Medicare provider payments scheduled for 2013?
  3. The Institute of Medicine (IOM) in a recent report on the future of nursing recommended that nurses should practice to the full extent of their education and training. The IOM called on Congress to amend the Medicare program to authorize advanced practice registered nurses (APRNs) to certify patients for home health care services. APRNs and physician assistants (PAs) can order Medicare skilled nursing facility care, but cannot place beneficiaries into more cost effective home health care. PAs are not permitted to continue to serve as an attending physician for their patients when they enter hospice. These professionals are taking on increased responsibilities in America’s health care system, especially in rural and other underserved areas. Would you support legislation that would permit APRNs and PAs to order Medicare home health services, and allow PAs to serve as attending physicians when their patients enter hospice?
  4. The Supreme Court held in Olmstead v. L.C. that state Medicaid programs were required under the Americans with Disabilities Act to undertake steps to support access to home care options as an alternative to institutional care. It has been long established that home care is cost effective, improves outcomes, and prevents more costly hospitalizations and nursing home stays. Do you believe it should be the responsibility of the state to ensure that beneficiaries understand and have available home care options before putting them in institutions? Should the federal government provide additional assistance to the states to rebalance their Medicaid programs in favor of home care?
  5. Medicaid and private pay providers have recognized the significant efficacy of using technology to supplement the services of health professionals. Tele-homecare technologies can enable the monitoring of patients at home from other locations. Medicare has not even included tele-homecare as part of post-acute care. Would you be supportive of at least conducting a Medicare pilot test of a tele-homecare benefit?
  6. Home care providers will be saddled with significant new responsibilities under the Affordable Care Act to provide insurance for their employees or pay a $2000 penalty for each full time employee. There are no provisions for increasing Medicare and Medicaid rates to accommodate these increased costs or any help for consumers who must pay privately for home care services. Would you support provisions to exempt home care providers from these new obligations? Would you support a requirement that all government health care programs adjust provider rates to meet the additional costs incurred to make health insurance available to all home care employees? Would you support providing tax credits to help individuals in need of home care services pay the increased cost resulting from the new employer obligations?
  7. Findings from numerous polls and studies indicate that the American public strongly supports increased public discussion of end-of-life treatments and wants to better understand the options available to them when faced with a terminal or life-limiting illness. Most importantly, people want to know that their wishes for treatment when they are seriously ill will be honored. What steps do you believe should be taken to increase the public discourse on care at the end of life, and to provide greater assurance to our citizens that their treatment choices will be honored?