Following up on earlier work analyzing the Medicare hospice benefit, the Department of Health and Human Services (DHSS) Office of Inspector General (OIG) issued two reports this week “which found that from 2012 through 2016, the majority of U.S. hospices that participated in Medicare had one or more deficiencies in the quality of care they … Read more

Last week, the Office of Inspector General (“OIG”) published a report[1] of its study on the growth in hospice utilization and reimbursement since 2005.  The Report summarizes key vulnerabilities in the Medicare hospice program affecting quality of care and program integrity, and presents recommendations to the Department of Health and Human Services for protecting beneficiaries … Read more

Mr. P. has been hospitalized after having a heart attack. He also has terminal cancer for which he wants to continue treatment. If Mr. P. is admitted as an inpatient for a total of three days while in the hospital, he can qualify for Medicare Part A coverage of subsequent Skilled Nursing Facility (SNF) stay … Read more

Hospice care is holistic care for the dying.  Medicare coverage of hospice care is available for beneficiaries who have been certified as terminally ill, for services that are “reasonable and necessary for the palliation or management of the terminal illness as well as related conditions.”  Prior to receiving Medicare coverage for hospice care, beneficiaries must … Read more

The Center for Medicare Advocacy submitted comments this week to the Centers for Medicare & Medicaid Services (CMS) concerning its proposed rule titled “Medicare Program; FY 2017 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements” (81 Fed. Reg. 25498), which was published on April 28, 2016.[1]  The Center’s comments focused on … Read more

Be a Resource for National Healthcare Decisions Day on April 16. There are numerous ways to participate at no cost, and the goal is simple: "To inspire, educate & empower the public & providers about the importance of advance care planning."  The easiset thing you can do is draw attention to your existing resources about advance care planning … Read more

When Emily Back was dying in early 2008, her treating physician prescribed a medication to help relieve her excruciating pain.  After the hospice provider refused to furnish the medication, her husband, in desperation, purchased it from the pharmacy, spending almost $6,000 of their own funds.  Mr. Back thought there must be some way to appeal … Read more

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 … Read more

By Howard Back, a Medicare Beneficiary from California Medicare funding for hospice services is a wonderful thing. But there is a missing element in the system: there is no timely way a hospice patient can appeal failure of a hospice to provide a drug, or piece of equipment or other service that the patient’s physician … Read more

Hospice care is specialized, compassionate care for those diagnosed with a limited life expectancy.  Good hospice care should enhance quality of life for the patient and should support caregivers.  The Medicare Conditions of Participation afford hospice patients certain enumerated rights including the right to choose one's own attending physician.  A new rule promulgated in the … Read more

Quick Summary When Medicare beneficiaries elect the hospice benefit, they waive Medicare coverage for all care and services related to the terminal illness that are not on the hospice plan of care and provided through the hospice provider.  This means that when a terminally ill beneficiary elects hospice, all of the medications needed to control … Read more

Research suggests that medications that should be covered by the Medicare Hospice Benefit are sometimes paid for by Medicare Part D plans. In March, to prevent this from happening, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, "Part D Payment for Drugs for … Read more

Some croon, "Everyone wants to go to Heaven, but nobody wants to die."  As a general rule, Americans not only don't want to die, we also don't want to talk about death and dying.  As a consequence of this reticence, many Americans are dying without the benefits of hospice care.  In an attempt to grapple … Read more

On March 10, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, "Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 Guidance" (Guidance).   The Guidance identifies a billing problem related to medications after Medicare beneficiaries elect hospice, and … Read more

Hospice is a program of care and support for people who are terminally ill.  To qualify for Medicare hospice coverage, a doctor certifies that a person is terminally ill, with an expectation of six months or less to live.  Once a person enters hospice, all their medical needs related to the terminal illness for pain … Read more

Back vs. Sebelius, 9th Circuit 7/5/2012 Although it dismissed the case, the U.S. 9th Circuit Court of Appeals today also confirmed that Medicare hospice patients have the right to appeal denials of services. The defendant, Secretary of Health and Human Services Kathleen Sebelius, acknowledged after this lawsuit was filed, that Medicare hospice beneficiaries have a … Read more

November is National Hospice Month.  The first White House proclamation honoring hospice month was signed by President Jimmy Carter in 1978. Access to care has improved significantly in the three decades since November has been celebrated as National Hospice Month.  At that time, hospices in the US served several thousand individuals and their family members … Read more

Eligibility for Medicare coverage of hospice care is contingent in part upon a hospice physician certifying that the beneficiary has a life expectancy of six months or less if the terminal illness runs its normal course.   In an effort to promote physician engagement in the process of certifying patients as eligible for the Medicare hospice … Read more

Hospice care is available for Medicare beneficiaries who are certified by a hospice physician as having a life expectancy of six months or less if the terminal illness runs its normal course. In 1983, the hospice benefit was designed to cover approximately 210 days of care. There were four benefit periods: two 90 day periods, … Read more

The Good: Connecticut Will Cover Hospice Care for Medicaid Recipients Medicaid recipients in Connecticut will soon have access to hospice care.  The new benefit closely resembles the Medicare hospice benefit.  To obtain hospice care, Medicaid clients must be certified as having a life expectancy of six months or less if the illness runs its normal … Read more