Medicare Hospice Benefit Remains Intact

December 10, 2003
There's been a good deal of debate surrounding the Medicare reform measure signed by President Bush earlier this month. But the National Hospice and Palliative Care Organization points out that the Medicare Hospice Benefit remained intact and was not altered. Additionally, new provisions are included that will improve access to hospice.

Designed to provide comprehensive coverage to Medicare recipients who are terminally ill, the Medicare Hospice Benefit will continue to be treated as a "carve out" for all Medicare programs, including the new Medicare Advantage program. This will assure all Medicare beneficiaries access to high quality hospice care regardless of which Medicare program they select.

In signing the measure, Bush said it was important to put personal choice at the heart of Medicare modernization efforts. The hospice group notes that the wishes and priorities of the patient have always been at the center of the hospice philosophy of care. Additional provisions to further strengthen the services hospices provide to dying Americans and their families include:

• Contracting Provisions (Section 946) Medicare-certified hospices will be allowed to contract with other Medicare-certified hospices for core services. This will help hospices provide core services when faced with situations such as unanticipated periods of high patient census or staffing shortages. The contracting proposal will help hospices provide coverage for traveling patients. This became effective upon enactment.
• Nurse Practitioners (Section 408) Nurse practitioners, not employed by a hospice, will be allowed to continue following their patients who elect hospice care. This became effective upon enactment.
• Hospice Educational Consultation (Section 512) This will allow for a one-time hospice consultation service for terminally ill Medicare beneficiaries. The service, which must be provided by a physician who is either the hospice medical director or an employee of a hospice program, would involve an evaluation of the individual's pain and symptom management needs, counseling regarding end-of-life issues and options for obtaining care, and advising the individual regarding advance care planning. This provision becomes effective January 1, 2005.
• A Rural Hospice Demonstration Project (Section 409) A CMS-developed project would establish three rural demonstration sites that would provide hospice care in residential facilities of 20 beds or less for beneficiaries who are unable to receive hospice care in their home. The demonstration sites would provide care inside the facility and not in the community. This demonstration project would be conducted over a period of not more than five years.

In his introduction to the President, HHS Secretary Tommy Thompson described the Medicare reform as a commitment to our seniors that would move the health care focus from treatment to prevention. Bush characterized the medicine of today as being comprised of outpatient care, disease screening, and prescription drugs and went on to remark, "Medicare hasn't changed, medicine has changed."