Proposal Presented for the Master Plan for Aging (#10)
Disclaimer
Throughout the MPA process, more than 100 proposals were developed thanks in particular to thousands of hours of work by external stakeholders and members of the public. These proposals and the MPA Council commentary are being submitted to the Governor and shared with policymakers and the public to inform policymaking. These proposals represent a starting point for discussion. Further discussion is necessary between relevant state agencies and stakeholders to both refine these proposals and assess which may be appropriate to adopt and implement.
Summary
Improve and preserve the quality and availability of hospice and palliative care. Recommendations include reestablishment of the Hospice and Palliative Care Education and Training Council, development of a Regulatory and Certificate of Need Task Force, funding for a stakeholder statewide coalition, offering an interdisciplinary palliative care benefit for qualifying Medicaid recipients regardless of location, and recognizing Physician Assistants as Hospice Attendings.
Justification
Preserving the quality and availability of hospice and palliative care services requires changes to service delivery, regulation interpretation, and increased knowledge about quality end of life services. In improving awareness of culturally and linguistically competent end of life care, improving certificate of need methodology, ensuring appropriate access to services, standardization, oversight, and funding, and ensuring alignment in regulatory and legislative interpretation, New York State can better protect the dignity of its residents and improve access to care quality end of life care.
Full Proposal
Improve and preserve the quality and availability of hospice and palliative care by:
- Re-establishing the Hospice and Palliative Care Education and Training Council, which would be responsible for reviewing professional training and educational curricula, represent the professions for feedback on curriculum impact and minimum standards for implementation within professions, determine the best method for implementing mandatory education as requirements for healthcare professional licensure renewal, benchmark utilization of current Medicare Advance Care Planning (ACP) physician billing and encourage expansion, discuss and develop proposals regarding Medicaid reimbursement rates for physician advance care planning conversations, consider claims-based quality metrics Advanced Care Planning codes, and provide input and proposals for improved interoperability of the Medical Orders for Life Sustaining Treatment (MOLST/eMOLST).
- Creating a Hospice Regulatory and Certificate of Need Task Force within DOH, charged with full review and related proposal for the Certificate of Need Application Process and Hospice Need Methodology. The Task Force should review proposal on hospice consumer safety from fraud, waste, and abuse, review consumer protection policies from other industries, develop a modern need methodology, consider increasing state surveys above the 3-year minimum, consider protections which may be needed within the state contracts to prevent the un-bundling of hospice services, and evaluate other means of performance feedback for newly approved hospices. The Task Force should also consider supporting the adequacy of the provision of personal care services.
- Funding a stakeholder statewide coalition to complete an assessment of the policies, practices, and access to quality palliative and hospice type services for incarcerated and recently released individuals with serious illness. The outcomes will include: An analysis of past data and circumstances surrounding all non-violent deaths within the prison system, compassionate release dispositions prior to death, including location of care, caregivers, hospitalizations, impact of associated timelines for Compassionate Release process, volume of approved vs. denied compassionate release, a health equity analysis of dying while incarcerated, outcomes of compassionately released individuals including medical and parole reports to ascertain issues with, or access to quality end-of-life in the community. This report will be presented to appropriate legislative and Department of Corrections and Community Supervision (DOCCS) leadership.
- Offering Medicaid recipients an interdisciplinary palliative care benefit upon identification of a qualified serious illness regardless of location of service or residence via a network of qualified licensed providers approved and registered by DOH.
- Allowing Physician Assistants to be recognized as Hospice Attendings consistent with federal authorization not requiring additional oversight or signature of the supervising physician.
Notes: Portions of this proposal are enacted.
MPA Council Commentary
This proposal is categorized as long-term and components of it are currently being implemented. DOH’s Center for Hospice and Palliative Care, which was established in 2024, works to ensure New York is positioned to support quality end-of-life choices, better living through routine ACP, and person-centered Hospice and Palliative care services. The Center continues to review recommendations from the Hospice and Palliative Care Education and Training Council and discuss Certificate of Need reform, Hospice Need Methodology, and the creation of a palliative care benefit. An assessment of reforms, scope, and efficacy could be required to implement this proposal. Potential statutory changes and fiscal implications would be evaluated in the context of the annual budget process and the availability of resources.