President Obama and Congress Act to Ensure Access to Compassionate End-of-Life Care for Patients and Families

One-Year Moratorium on Cuts in Medicare Hospice Funding Signed Into Law

The nation’s hospice community claimed a significant victory this week after President Barack Obama signed a bill (H.R. 1-The American Recovery and Reinvestment Act of 2009) into law that includes a one-year moratorium on cuts in Medicare funding for the more than 4,700 hospice programs nationwide. The action ensures that access to quality and compassionate end-of-life care will be maintained for the more than 1.4 million patients and their family caregivers who seek hospice each year.

Over the past year, the National Hospice and Palliative Care Organization, the Alliance for Care at the End of Life, and hospice advocates from across the country have been working to overturn a 2008 regulation issued by the Centers for Medicare and Medicaid Services, which eliminates a key component of the Medicare hospice reimbursement formula known as the budget neutrality adjustment factor (BNAF).

The phased funding cut would have taken $135 million away from quality and compassionate end-of-life care in fiscal year 2009, and has already jeopardized the survival of many hospice programs, particularly smaller, more rural ones. Approximately 3,000 hospice provider jobs were threatened to be cut this year, with deeper job losses expected in fiscal year 2010 as the funding cut enters its second year.

The effort to halt the hospice rate cuts has been underway since the Bush Administration announced its intention to eliminate the BNAF in its FY09 budget.

NASW and NHPCO with its partners within the hospice community have been engaged in an aggressive grassroots program, mobilizing patients and their families, social work professionals, physicians, nurses, home health aides, spiritual and bereavement counselors, and volunteers, that has resulted in tens of thousands of calls, emails and letters being sent to elected officials in the House and Senate. As a result, a bipartisan group of lawmakers worked together to have the hospice provision included in the economic stimulus package approved by Congress, and signed into law by President Obama.

“From the start, our efforts have been about ensuring access to high-quality and compassionate end-of-life care for Americans coping with life-limiting illness. We thank our supporters at the grassroots level and in Congress for securing a one-year moratorium on cuts in hospice funding. It’s important that we continue to build upon the momentum that we have now to ensure that patient access is protected in future years by permanently overturning these devastating rate cuts,” said J. Donald Schumacher, president and CEO of NHPCO.

Despite strong, bipartisan opposition in Congress, CMS began implementation of the final rule on October 1, 2008. “If allowed to move forward in FY10, this misguided rule will slash hospice payments by approximately $2.18 billion in the first five years, despite the fact that hospice has been found to be a cost saver for the Medicare program,” Schumacher noted.

A 2007 independent Duke University study found that hospice reduced Medicare costs by an average of $2,300 per hospice patient, amounting to a total of more than $2 billion in savings in a single year.

With the one-year moratorium in place, NHPCO, the Alliance for Care at the End of Life, and Hospice Advocates will now turn their attention to working with the new administration and Congress on permanently overturning the CMS rule to eliminate the BNAF.

NHPCO leadership are meeting with CMS on February 19 to discuss the subsequent process necessary to address the one-year moratorium.

National Hospice and Palliative Care Organization is the oldest and largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. NHPCO’s mission is to lead and mobilize social change for improved care at the end of life.

National Association of Social Workers (NASW) is the largest membership organization of professional social workers. NASW promotes, develops, and protects the practice of social work and social workers and seeks to enhance the well-being of individuals, families, and communities through advocacy.