NurseWeek

Hospice coverage limit misunderstood

"Medicare is committed to ensuring that beneficiaries receive appropriate care tailored to their own needs at the end of life and that they understand their rights and options."
~ Nancy-Ann DeParle, director, Health Care Financing Administration

By Keith W. Murrow
Health24News
September 16, 2000


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WASHINGTON (H24N) – In an attempt to dispel a "disturbing misconception" about Medicare reimbursements associated with hospice stays, outgoing Health Care Financing Administration Director Nancy-Ann DeParle has penned a scathing letter to all 2,200 of the nation’s hospice centers informing them of Medicare’s hospice benefits.

"I am concerned that some individuals who want and could benefit from hospice care may not be receiving it or may be receiving it late in the course of their illness because the difficulty in making end-of-life prognoses may affect their access to hospice care," DeParle wrote. "Nothing could be further from the truth."

Current Medicare guidelines allow patients at the end of life the chance to seek special care in hospices, even psychological care, but to qualify the patients are required to provide physician certification, deeming them so ill that they will die within six months.

DeParle’s letter stresses to the hospice caretakers and directors that the rules are to the contrary of the rumors; those patients who outlive their doctors’ prognoses are covered under Medicare.

"There have been a handful of cases in which beneficiaries who were not carefully diagnosed in the first place were inappropriately enrolled in hospice," she wrote. "Nevertheless, that is very different from situations in which a terminally ill patient has had the good fortune to live longer than predicted by a well-intentioned physician."

DeParle defined the rules for the caregivers:

In no way are hospice beneficiaries restricted to six months of coverage.
There is no limit on how long an individual beneficiary can receive hospice services, as long as they meet the eligibility criteria.
As long as physician continues to properly and conscientiously recertify the six-month prognosis, a beneficiary can continue to receive the hospice benefit.

DeParle suggested in the letter that a pilot program be initiated where physicians authorize patients whose diagnoses are questionable and their stay at hospice could outlast the six-month deadline. Within the proposed program, doctors could update their prognosis and, if death were predicted to occur within six months, make the patient eligible for continued hospice care.

She also encouraged hospices to tell beneficiaries and their families to familiarize themselves with the Medicare hospice benefit guide, which explains to beneficiaries what is covered under the government’s health insurance.