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Volume 24.10

The Hospice Care Accountability, Reform, and Enforcement Act of 2024 (“Hospice CARE Act of 2024”), currently in draft form, would eliminate coverage of certain aide and homemaker services.  The draft legislation would make the following changes (changes in bold) effective on or after October 1, 2026, to existing regulations.

42 U.S. Code § 1395x – Definitions

“The term “hospice care” means the following items and services provided to a terminally ill individual by, or by others under arrangements made by, a hospice program under a written plan (for providing such care to such individual) established and periodically reviewed by the individual’s attending physician and by the medical director (and by the interdisciplinary group secured in paragraph (2) (b) of the program –

(D) (i) in the case such individual is not residing in a skilled nursing facility or a nursing facility, services of a home health aide who has successfully completed a training program approved by the Secretary and in the case such individual is not residing in a skilled nursing facility or a nursing facility, homemaker services,”

This provision of the draft legislation goes directly at the assumption that Medicare payments for patients residing in nursing home settings are too high and that a duplication of payment occurs when considering payments to the nursing home and to the hospice.  The provision would remove the requirement of the hospice to provide aide and homemaker services to hospice patients residing in a nursing home setting.

Implementation of this provision would trigger a reduction in payments to the hospice for a routine home care day when the patient resides in a nursing home setting.  The draft legislation provides no indication as to how any payment reduction would be initially determined (the draft legislation includes provisions for rebasing hospice payments in the future).  Additionally, hospices would be expected to segregate aide and homemaker services provided to patients residing in a nursing home on the Medicare cost report as such services would not be considered a covered hospice service.

Such a change would seem to indicate that the nursing homes have the financial responsibility for the provision of all aide and homemaker services; however, such services would not appear to be under the direct control and supervision of the hospice.  Any aide and homemaker services for these nursing home residents provided directly by the hospice would be non-reimbursable as a noncovered service.


Registrations are now being accepted for the 2024 Hospice Financial Administration Conference scheduled for September 30 – October 1, 2024, in Phoenix.  Details, including hotel reservations, are available here.

The program will pay significant attention to the apparent direction of payment reforms and additional integrity efforts.  While many provisions of the draft legislation known as the Hospice CARE Act of 2024, may not go any further, or may be modified, the draft is reflective of issues getting federal attention.  As such, hospices need to look carefully at the numerous payment revisions and additional program integrity provisions under consideration.

As with all programs sponsored by The Health Group, LLC, attendance is limited to maximize the program benefits.  We encourage you to register and get room reservations early.  The early registration discount is available through July 31, 2024.  If you have any questions do not hesitate to contact us at conference@healthgroup.com.