On December 27, 2020, H.R. 133, the Consolidated Appropriations Act, 2021 became public law. This 5,593-page year-end legislative package included a policy provision which should be of interest to hospice and palliative care social workers. Part of the “Helping Our Senior Population in Comfort Environments Act”, also known as the HOSPICE Act H.R. 5821, is a requirement for survey and enforcement procedures to improve consistency and oversight for hospice programs. 

Federal oversight of hospice programs is not a new development. The Hospice Quality Reporting Program (HQRP), established in 2010 with the passage of the Affordable Care Act, mandated quality reporting requirements for hospice programs. Since that time, to provide transparency to consumers and improve care to hospice patients, hospices have been required to both measure and report quality care measures. The Hospice Act differs from the HQRP, in that it provides more detail about surveyor training, the survey process, and intermediate sanctions for hospices.  Surveys will continue to be required every 36 months and if there is more than one surveyor (required to be a nurse), it can be conducted by other members of the interdisciplinary team. The interdisciplinary surveyor team is an important opportunity for hospice social workers, in that it includes for the first time, the potential for professional social work oversight to be included in a Center for Medicare & Medicaid Services (CMS) hospice survey. 

Now that this provision is part of federal law, the next step is for CMS to develop regulatory text and guidance for the changes in hospice surveys, which will then be passed to individual states and accrediting organizations to implement. As CMS begins this process, key stakeholder input has been requested.  The National Coalition for Hospice and Palliative Care (the Coalition) coordinated a group of diverse hospice stakeholders, including SWHPN, to meet with Thomas Pryor, Program leader for Hospice Survey and Certification at CMS, on Friday, January 29, 2021. Members of the SWHPN board attended this first outreach meeting to represent the profession of hospice social work, and to better understand how this new law might impact social workers.

Representation of the core interdisciplinary team of chaplaincy, social workers, nursing and physicians has been a mandate for hospice care teams since the 1983 Medicare Hospice Benefit regulations were published. However, until now, surveyors have been almost universally nurses, so this change will allow social workers and other disciplines with experience in hospice to be part of the hospice survey team.  The state survey agency or accrediting organization will determine whether the survey will be done by more than one person.  It is possible that hospice social workers will be able to seek state government or accrediting organization employment opportunities as surveyors for Medicare hospice certification and recertification.  This will help promote the inclusion of social work values and priorities in hospice program survey oversight. It is possible, but not yet confirmed, that this change to the survey process will be part of the FY 2022 Hospice Wage Index proposed rule expected to be published in April, 2021 for public comment.      

The Coalition supports the interdisciplinary approach to establishing survey teams from various hospice disciplines and hopes that it provides opportunities to improve the approach as a proactive, rather than reactive process. Continued partnership with the Coalition and its members, updates on social work involvement in this important new law, and opportunities to comment further on this important topic will be reported to our SWHPN membership as they evolve.