A lawmaker introduced a bill to Congress requiring Medicare Advantage (MA) plans to pay for hospice care, creating potential fallout for home health providers that offer hospice services.
Mollie Gurian, vice president of policy and government affairs at LeadingAge, an association of nonprofit providers of aging services, called the bill, H.R. 3467, “very ill-conceived.”
“Not allowing beneficiaries to change plans would likely create less competition and plan accountability for access to care in the marketplace,” Gurian told Home Health Care News’ sister publication, Hospice News. “Our home health and [skilled nursing facility] (SNF) members struggle with Medicare Advantage plans already. While reforms are needed, these are not the right reforms and frankly, these would decimate both the MA plans and providers trying to provide care. Choice has been a fundamental piece of the Medicare program and one that needs to continue.”
Rep. David Schweikert (R-Arizona) introduced the bill on May 15, which was then referred to the Committee on Ways and Means. The bill’s full text is not yet available.
If passed, the bill would be a “radical change,” according to Gurian. Currently, hospice is kept separate from MA, and when an MA beneficiary elects for hospice care, their coverage changes to fee-for-service (FFS) Medicare. Gurian said this ensures that hospice remains a managed, holistic benefit outside of MA.
“It would reduce beneficiary choice and access to care via MA default enrollment, which would lock beneficiaries into one MA plan for three years, even if plan benefits, provider networks, or costs to the enrollees change annually.”
The Center for Medicare and Medicaid Innovation (CMMI) has previously attempted to entangle MA with hospice benefits – to no avail. The Value-Based Insurance Design (VBID) tried to wrap hospice care and other services into the MA program in a modernization attempt, but the Centers for Medicare & Medicaid Services (CMS) ended the demonstration at the end of 2024. Home-based care providers were largely pleased that the program ended.
MA has been an increasingly critical struggle for home health providers. While reforms are necessary, Gurian said, the new bill would not be a step in the right direction.
