NPHI Urges CMS and State Medicaid Agencies to Exempt Hospice and Palliative Care Patients

Comment letter calls for clear implementation guidance to protect seriously ill beneficiaries from unnecessary administrative burdens

[WASHINGTON, D.C.] — The National Partnership for Healthcare and Hospice Innovation (NPHI) has submitted to the Centers for Medicare & Medicaid Services (CMS) and shared with state Medicaid directors a comment letterurging policymakers and regulators to ensure that individuals receiving hospice and palliative care services are explicitly exempt from Medicaid community engagement requirements during implementation of CMS’s Interim Final Rule (CMS-2454-IFC).

The Interim Final Rule (CMS-2454-IFC), issued by CMS on June 1, would implement the statutory Medicaid community engagement requirements established by Congress for certain Medicaid expansion beneficiaries while supporting CMS’s objective of ensuring individuals who are medically unable to meet those requirements retain access to health coverage.

NPHI expresses concern that the rule does not sufficiently address how states should identify and exempt individuals receiving hospice or palliative care services.

“We greatly appreciate CMS’s recognition that individuals who are medically unable to meet community engagement requirements should retain access to Medicaid coverage,” said Tom Koutsoumpas, Founder and CEO of NPHI. “However, the rule does not provide sufficient guidance on how states should identify and exempt individuals receiving hospice care or individuals with serious illness who are actively receiving palliative care services. We urge CMS and state Medicaid agencies to provide explicit guidance to ensure these medically vulnerable beneficiaries are appropriately exempt from community engagement requirements.”

NPHI notes that hospice and palliative care patients frequently experience significant symptom burden, functional limitations, caregiver dependence, and rapidly changing medical circumstances. While many individuals may ultimately qualify for existing exemptions based on disability, medical frailty, or other serious health conditions, implementation decisions at both the federal and state levels will determine whether beneficiaries experience unnecessary administrative burdens or interruptions in coverage.

“Implementation matters,” said Ethan McChesney, Senior Policy Director at NPHI. “CMS and state Medicaid agencies should adopt implementation approaches that proactively identify hospice and palliative care patients and ensure they are not inadvertently subjected to community engagement requirements. They can do this by leveraging existing Medicaid eligibility, claims, encounter, and provider data can help protect medically vulnerable beneficiaries while minimizing unnecessary administrative burdens for patients, caregivers, and providers.”

NPHI’s comment letter outlines several recommendations to help CMS and state Medicaid agencies promote consistent implementation while protecting medically vulnerable beneficiaries.

Read the full comment letter and recommendations here.

NPHI Comment Letter_Medicaid CER IFR

NPHI looks forward to working with CMS and state Medicaid agencies to support implementation approaches that recognize the unique circumstances of hospice and palliative care patients, preserve uninterrupted access to care, and ensure medically vulnerable beneficiaries are not inadvertently subjected to community engagement requirements.

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