Improving Access to Transfusion Care for Hospice Patients Act of 2025
- Sponsor
- Sen. Rosen, Jacky [D-NV]
- Committees
- Finance Committee (primary)
- Last action
- Jun 3, 2025
Bottom line
The bill aims to improve access to blood transfusions for hospice patients by removing a financial disincentive for hospice providers to offer this care, potentially increasing Medicare spending.
What it actually does
This bill mandates the Center for Medicare and Medicaid Innovation (CMI) to establish a new payment model within one year of enactment. This model will test paying for blood transfusions furnished to Medicare hospice patients separately from the existing all-inclusive per diem payment. The separate payment would be at the rate Medicare would typically pay if the patient were not in hospice.
Proponents argue
Supporters argue that the current Medicare hospice payment model, which bundles all services into a per diem rate, creates a financial disincentive for hospice providers to offer costly services like blood transfusions. This can lead to hospice patients not receiving transfusions that could significantly improve their quality of life, even if not curative. Separating this payment would ensure patients receive necessary palliative care.
Opponents contend
Critics might express concern that carving out specific services from the all-inclusive per diem payment could undermine the foundational principle of hospice care, which emphasizes comprehensive, coordinated care within a fixed budget. They might also worry about potential for increased Medicare spending if not managed carefully, or that it could open the door for other services to be carved out, complicating the payment structure.
The bill is very short and clear, making it highly accessible for a quick review.
Section 2, amending Section 1115A of the Social Security Act
Mandate for CMI to Test Separate Payment for Hospice Blood Transfusions
This provision requires the Center for Medicare and Medicaid Innovation (CMI) to develop and implement a new payment model within one year. Under this model, blood transfusions provided to individuals receiving Medicare hospice care will be paid for separately, rather than being included in the daily hospice payment. The payment amount for these transfusions will be the standard Medicare rate, as if the patient were not in hospice. The CMI is also required to evaluate this model against specific metrics related to patient care and utilization.
Supporters argue
Supporters argue that this change directly addresses a gap in palliative care for hospice patients. Many patients with conditions like myelodysplastic syndromes or certain cancers could benefit significantly from transfusions to alleviate symptoms like fatigue and shortness of breath, improving their quality of life in their final months. The current bundled payment often makes it financially unfeasible for hospices to provide this care, forcing patients to disenroll from hospice or go to emergency rooms for transfusions.
Critics contend
Opponents might argue that carving out specific services could lead to 'unbundling' of hospice care, potentially increasing overall Medicare costs and fragmenting care coordination. They might also suggest that if transfusions are truly essential, hospices should already be incorporating them into their care models, and a separate payment could incentivize unnecessary transfusions.
Tradeoffs
The bill balances the desire to improve access to specific palliative treatments for hospice patients against the potential for increased Medicare spending and the administrative complexities of carving out services from a bundled payment model. It also navigates the tension between the comprehensive, all-inclusive nature of hospice care and the specific needs for high-cost interventions.