IMPACT Act Legislation Passed

NHPCO Applauds Passage of the IMPACT Act
Hospice provisions added to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) will create increased transparency within the hospice community.

(Alexandria, Va.) –  This week, the U.S. House of Representatives and Senate passed the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). This legislation includes several hospice integrity provisions that are backed by the hospice community. The National Hospice and Palliative Care Organization supports this legislation and applauds the additional oversight it will bring to end-of-life care providers.

The IMPACT Act (H.R. 4994), requires more frequent surveys of hospice providers – a measure the hospice community and NHPCO has championed for more than a decade. The bill mandates that all Medicare-certified hospices be surveyed at least as frequently as every three years for at least the next ten years.

A 2007 HHS Office of the Inspector General report found that current survey measures for Medicare-certified hospices was not providing sufficient oversight.

“Currently, hospices can go eight years or more without ever being surveyed, which is far too long,” said J. Donald Schumacher, NHPCO president and CEO. “More consistent surveys, and the process providers go through to prepare for them, will help hospices and ultimately benefit the patients and families in their care.”

Additionally, the new legislation will facilitate medical reviews for hospice programs with a soon to be determined percentage/number of patients receiving care for more than 180 days. The specific patient load that would trigger this medical review is yet to be set by CMS.

Such a medical review of what are known as “long stay” patients will help ensure that hospices are caring for individuals with life-limiting illnesses that are often harder to prognosticate than in the earlier days of hospice care when most patients had a cancer diagnoses.

NHPCO has supported this provision since it was originally recommended by MedPAC in 2009.

The legislation also includes a provision that would align hospice reimbursement and the hospice aggregate financial cap to a common inflationary index. NHPCO has continually supported the existence of the cap as a cost containment mechanism that works to prevent inappropriate financial incentives for hospice programs.

“Under NHPCO’s leadership, the hospice community has been on the frontlines of advocating for increased transparency, program integrity, and accountability. We believe that the hospice provisions included in the IMPACT Act are critically important steps in this direction,” stressed Schumacher.

NHPCO reports that more than 1.5 million dying Americans receive care for the nation’s hospice providers every year and hospice provides the kind of care people want at the end of life.

To learn more about hospice and how it helps patients and families or to find a hospice in your community, visit the website Moments of Life: Made Possible by Hospice.


Anita Brikman
Senior Vice President, Strategic Communications
Ph: 703-837-3154

Editorial Note: NHPCO’s Health Policy staff will be available for a more in-depth discussion.