Eli's Hospice Insider

Published on Wed Dec 28, 2016 PDF

Experts anticipate these possible changes under new administration.

Whether the Trump Administration benefits or harms hospice providers remains to be seen, but President-Elect Trump’s pick for HHS leader is encouraging.

Trump recently announced Rep. Tom Price (R-Ga.) as his nominee for Department of Health and Human Services Secretary and consultant Seema Verma as his pick for Centers for Medicare & Medicaid Services Administrator.

Price, a practicing orthopedic surgeon for 20 years before entering politics, has sided with home health agencies over the Pre-Claim Review demonstration. In May, Price spearheaded a letter signed by 116 members of Congress urging CMS to withdraw PCR. In a Sept. 7 House Ways and Means Health Subcommittee hearing on quality in Medicare Part A, Price questioned Almost Family President Steve Guenthner about PCR and raised the idea of a PCR delay and reform of face-to-face requirements. He also questioned the Home Health Value-Based Purchasing withhold level that will reach 8 percent, when other provider types’ VBP withhold levels are capped much lower at 1 or 2 percent. And later that month he introduced, along with Rep. James McGovern (D-Mass.), the Pre-Claim Undermines Seniors’ Health (PUSH) Act that called for imposing a one-year moratorium on PCR in all demonstration states and requiring CMS to report to Congress on PCR’s impact on patients, home health agencies, physicians, and Medicare spending.

In light of those actions, the Visiting Nurse Associations of America “is grateful to Rep. Price for his strong advocacy on behalf of home-based care,” says VNAA’s Joy Cameron.

The National Association for Home Care & Hospice calls Price “a staunch supporter of home care.” NAHC’s Val Halamandaris says, “We look forward to working with Dr. Price in his capacity as Secretary of the U.S. Department of Health and Human Services. He has a deep understanding of the value of home care and hospice that we expect will be key to his actions with Medicare and Medicaid.”

The trade group for Price’s home state has more praise for the lawmaker. “We have worked closely with Congressman Price since he was elected and he is a huge home care advocate and supporter of children’s health care issues on the Republican side of the aisle,” says Judy Adams of the Georgia Association for Home Health Agencies. “We are thrilled with his nomination and know that he will always be a true champion of patients and their families. As Secretary of HHS we know that Congressman Price will work tirelessly to ensure that all patients get the care they so richly deserve,” Adams tells Eli.

CMS Administrator May Value Home Care

CMS Administrator nominee Verma is less of a known quantity. Her nomination appears to be related to Vice President-Elect Mike Pence, with whom she worked as a consultant on Indiana’s Medicaid revamp known as HIP 2.0. Verma, who has an MPH from Johns Hopkins University, has also worked with other states on adding Medicaid program requirements such as beneficiary cost-sharing and lock-outs for failing to pay premiums.

The pick could be an encouraging signal for home care, suggests attorney Robert Markette Jr. with Hall Render in Indianapolis. “Her nomination may tell us more about the future of Medicare overall,” Markette tells Eli. “In Indiana under Pence … we have seen the Medicaid administration much more interested in home health and home- and community-based services. They see it as a cost-effective solution and have really been looking at expanding money to home- and community-based services as well as redesigning our state Medicaid reimbursement model to provide better reimbursement.”

“I don’t know how that will translate going forward, but I am optimistic,” Markette adds.

Take A Peek At Health Care Crystal Ball

While the health care policy future under the Trump Administration is far from clear, statements made on the campaign trail and recent developments suggest these items may lie ahead, NAHC suggests:

Con: Hospice in Medicare Advantage. Republican lawmakers have been circling the idea of eliminating the hospice carve-out under MA.

Con: More Medicare Advantage. While campaigning, President-Elect Trump said he would not touch Medicare. But recent signals indicate privatization for both Medicare and Medicaid may be on deck. While some MA payers are good partners, others set too-low rates and restrict home care coverage. Plus, navigating numerous billing and eligibility systems is burdensome.

Pro: Axing the employer mandate. Trump campaigned heavily on eliminating the Affordable Care Act, and Price has been a vocal critic of the law. While the Administration is likely to keep popular parts of the law such as coverage for pre-existing conditions, onerous sections such as the employer mandate to provide health insurance are likely to get cut.

Pro: Eliminating IPAB. The Independent Payment Advisory Board, sometimes called “Super-MedPAC,” is still waiting for implementation. Don’t be surprised to see the body that would have rate-cutting power abolished.

Pro: Lightening regulatory burden. Providers hope the Trump administration will tame the Medicare paper dragon by eliminating unnecessary regulatory burdens and rushed implementation of demonstration concepts, among other things.