Hospice Quick Reference
Hospice care is compassionate end-of-life care that includes medical and supportive services intended to provide comfort to individuals who are terminally ill. Care is provided by a team. Hospice is often called “palliative care,” because it aims to manage a patient’s illness and pain, but does not treat the underlying terminal illness.
Hospice care is covered by Medicare if all of the following are true:
- The patient is terminally ill and has elected Medicare hospice coverage. Patients are entitled to two 90-day election periods, followed by an unlimited number of 60-day periods. (Note: The attending physician (if one exists) and the medical director or physician member of the hospice interdisciplinary team must have certified in writing at the beginning of the first 90-day period that the patient was terminally ill. For all subsequent election periods, only a hospice physician must certify that the patient is terminally ill).
- The patient or his or her representative has signed and filed a hospice election form with the hospice of choice.
- The hospice provider is Medicare-certified.
To get the most out of hospice care:
- Choose an attending physician who is not affiliated with the hospice provider.
- Participate in bi-weekly interdisciplinary group care planning meetings.
- Make sure the plan of care includes:
- Interventions to manage pain and symptoms;
- Detailed statement of the scope and frequency of services necessary to meet the specific patient and family needs;
- Drugs and treatment necessary to meet the needs of the patient;
- Medical supplies and appliances necessary to meet the patient’s needs.
- If the care plan does not meet the patient’s needs contact:
- The hospice nurse in charge of coordinating the care plan.
- The attending physician.
- State’s Department of Public Health
- State’s Quality Improvement Organization (QIO – for contact information see https://www.qualitynet.org/dcs/ContentServer?pagename=QnetPublic%2FPage%2FQnetTier2&cid=1144767874793)
- CMS Regional Office (http://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/index.html?redirect=/regionaloffices/)
- Joint Commission (certification and accreditation organization – see http://www.jointcommission.org/)
Hospice appeals are complex and often difficult, as evidenced by the experience of Howard Back. For information on both expedited and standard appeals as they should work, see http://www.medicareadvocacy.org/medicare-info/medicare-hospice-benefit/#HOSPICE_MEDICARE_APPEALS.