HR-9703-119
Referred to the House Committee on Ways and Means.
Sponsored by Debbie Dingell (D-MI)
What it does
This bill would require the Center for Medicare and Medicaid Innovation (CMMI) to design and run a pilot program — within one year of enactment — testing whether blood transfusions for Medicare hospice patients should be paid for separately, rather than bundled into the fixed daily hospice payment that currently covers all care. Under the current system, hospices receive one all-inclusive daily rate and must cover transfusions out of that amount. Under the pilot, transfusions would be reimbursed at the same rate Medicare pays for transfusions outside of hospice. The bill also requires CMMI to evaluate the pilot by comparing participants to similar non-hospice patients on metrics including hospital use, chemotherapy in the final two weeks of life, and transfusion frequency.
Who benefits
Medicare hospice patients who need blood transfusions for symptom relief (e.g., those with blood cancers, chronic anemia, or other conditions causing fatigue and shortness of breath) and who may currently be denied or under-provided transfusions because hospices cannot afford them under the fixed daily rate. Hospice providers, particularly smaller or nonprofit hospices, that currently absorb transfusion costs within the per diem and may be financially strained. Patients' families, who may see improved comfort and quality of life for their loved ones. Researchers and policymakers who would gain data from the evaluation metrics on end-of-life care patterns.
Who is hurt
Medicare's Hospital Insurance Trust Fund, which could face higher spending if transfusions are billed separately at full Medicare rates in addition to the existing per diem. Taxpayers broadly, as increased Medicare expenditures are ultimately publicly funded. Potentially, hospice patients if the pilot's evaluation metrics lead to scrutiny that results in tighter restrictions on transfusion access. Competing healthcare priorities that could receive less funding if Medicare spending increases. Hospices that may face new administrative burdens tracking and billing transfusions separately from their standard per diem claims.
Supporters argue
Supporters argue that the current all-inclusive hospice per diem creates a financial disincentive for hospices to provide blood transfusions, which can meaningfully reduce suffering — alleviating fatigue, breathlessness, and pain — for patients with conditions like leukemia or myelodysplastic syndrome. They contend that patients should not have to forgo comfort-focused transfusions simply because they have chosen hospice care, and that the pilot would generate rigorous, evidence-based data to determine whether separate payment improves access without encouraging overuse. They point out that CMMI was specifically created by the ACA to test exactly these kinds of payment model innovations before broader adoption.
Opponents argue
Opponents argue that unbundling transfusions from the hospice per diem undermines the foundational philosophy of hospice — a holistic, comfort-focused benefit deliberately structured as an all-inclusive payment to discourage piecemeal, procedure-driven care at the end of life. They contend that separate billing could incentivize overuse of transfusions in hospice settings, driving up Medicare costs without clear evidence of proportional patient benefit, and that the evaluation metrics — including chemotherapy use and ICU days — suggest the pilot could blur the line between curative and palliative care, potentially distorting the hospice benefit's purpose.