C-TAC regularly submits comments on proposed federal regulations on those aspects that affect serious illness care. This is a lesser-known form of advocacy as legislation only becomes actionable when it’s translated into regulations. The federal regulatory process requires agencies to submit all proposed regulations for a 60-day public comment period. All comments are then reviewed and some are acknowledged in the final rules.
C-TAC was successful in that comments on the proposed hospice, skilled nursing facility (SNF), and Hospital Inpatient rules were acknowledged in the final rules. While those comments didn’t change the final rules, CMS said they would take them under consideration for future rulemaking, which is the only way to influence the federal regulatory process.
Here is the acknowledgment of C-TAC comments in those final rules:
- Advance care planning– We recommend that advance care planning be mandatory in all Medicare programs and our comments for doing so for the Hospice quality reporting program were specifically acknowledged:
- “Commenters suggested that CMS develop or revise quality measures to better reflect how hospices meet patient care goals. These suggestions included new quality measures for advance care planning and patient-reported measures related to how much patients felt understood and whether patients received the pain help they wanted”.
- “We appreciate the input regarding quality measure development and will take these comments into consideration for future quality measure development initiatives”.
- Screening for social drivers of health– CMS has also included requests for input about whether and how to screen for social drivers of health/ risk factors. C-TAC has consistently supported such screening and advocated for it to be broadened to include family caregivers since their lack of support can result in unplanned hospitalizations. We have also asked that Medicare programs require any positive screenings to result in referrals to needed services and even to ensure such services are available or were able to be accessed. These comments were acknowledged in two of the three rules:
- Hospital inpatient rule: “A few commenters described how the burdens experienced by patients with health-related social needs often extend to caregivers” and “Many commenters acknowledged that the measurement data can be leveraged to support investments in and linkage to community resources; for example, building closed-loop referrals that link patients, healthcare providers, and community resources”.
- Hospice rule: “Several commenters recommended the inclusion of caregiving status information” when screening for social drivers of health.
- Advance directive interoperability– CMS has funded an effort to make advance directives interoperable across the electronic health records of all post-acute settings. We have supported this effort and commented on it in all three of these rules. Those comments are acknowledged in both the hospital inpatient rule and the SNF rule. For the latter, we apparently were the only ones who commented and they almost quoted our comments back:
- “We received one comment on the information provided in this section. The commenter expressed support for efforts across HHS to advance health information technology exchange and encouraged the use of a standard set of data by providers and health IT vendors, including efforts through the PACIO project. The commenter also noted a recent National Academies report describing technology barriers for PAC settings due to not being eligible for previous incentives to purchase technology certified under the ONC Health IT Certification Program. The commenter supported recommendations in the report for HHS to pursue financial incentives for post-acute care settings to adopt certified health information technology in order to enable health information exchange…We will take this comment into consideration as we coordinate with Federal partners, including ONC, on interoperability initiatives, and to inform future rulemaking”.
