Affording Hospice Care
Patients are admitted to Family Hospice based their need and not their ability to pay.
The Centers for Medicare and Medicaid Services (CMS) have established admission criteria to assist hospices and physicians in identifying when a patient is eligible for hospice care. Physicians must sign a certification statement that says that the physician believes “the patient has a prognosis of 6 months or less if the disease runs its normal course”.
Medicare Hospice Benefit – Part-A
Hospice receives a daily reimbursement to provide care to a patient and support to the family. The Hospice must provide services and supplies that the patient will need to improve their quality of life. This care is limited to comfort measures and supportive care and not aggressive or curative measures.
SERVICES AND SUPPLIES:
| Skilled Nursing Care Personal Care Services Medical Social Services Spiritual Care PT, OT, Speech Therapy Counseling Services 24 hour “On Call” Services |
Home Medical Equipment Prescriptions related to the terminal illness and related conditions Medical Supplies Oversight by the Hospice Medical Director |
Continuous Home Care:
LEVELS OF CARE:
Routine Home Care:
Patients receive home care services in their home, assisted living center or nursing home. Hospice staff members make scheduled intermittent visits to assist the family with the care the patient needs.
During a period of crisis, it may be necessary for the Hospice Nurse to work with the patient in order to stabilize the patient’s condition. This care is usually lasting between 8 and 72 hours due to intractable pain or new symptom.
Respite Care:
A short term (limited to 5 days) of care provided by the Hospice in a contracted facility to provide a break in the day to day care of the patient.
General Inpatient Care:
Short term care in the hospital or special unit used to provide symptom management when symptoms cannot be managed at home. Once the symptoms have subsided, the patient will return home.
Nursing Home Room and Board
Medicare does not offer nursing home room and board payment for patients on hospice. If the patient qualifies for Medicaid, the hospice is able to bill Medicaid and reimburse the nursing home for their usual and customary charges minus the patient responsibility.
Private Insurance
Many insurance programs offer a hospice benefit subject to co-pays and deductibles.
Medicare Pharmacy Part D
The Medicare Hospice Benefit pays for prescriptions related to the terminal illness and related conditions.
It is the responsibility of the Hospice program to list all the medications a patient will receive while on hospice and to identify which medications are related to the terminal illness and which medications are the responsibility of the patient. This list is reviewed by the hospice team and patient’s physician.
