Room and board Medicare doesn’t cover room and board for hospice care. It does not cover the cost of rent or fees for a home, nursing home or assisted living. However, if the hospice medical team determines that your loved one needs short-term inpatient or respite care services that they arrange, then the stay in the nursing home or assisted living facility is covered. If your loved one’s permanent home was already in the nursing home, hospice care is covered. Your loved one may have to pay a small copayment for the respite stay.
Medicare & Cost of Hospice
VITAS hospice patients who meet those qualifications will have their hospice care covered by Medicare. For care unrelated to a patient’s terminal illness, Medicare and Medicaid continue to provide their usual benefits. Since each private insurance company has its own policies regarding hospice coverage, VITAS can contact the patient’s insurer to ask about coverage provided. However, VITAS is committed to admitting and caring for all hospice-appropriate patients who are referred to us, regardless of their insurance coverage or ability to pay.
Medicare Hospice and Respite Coverage
When you or a loved one becomes a hospice patient, the last thing you want to worry about is insurance coverage. The final stages of a fatal disease can be mentally, emotionally, physically, and financially devastating for patients and their families. Hospice care is available under Medicare Part A to help ease the burden in all four of the above areas.
Medicare coverage of hospice care
. The third benefit period begins on day 180 of hospice. After that, you must continue to have face-to-face meetings with a hospice doctor or nurse practitioner before the start of each following 60-day benefit period. The meeting must take place no earlier than 30 days before the new benefit period to confirm you still qualify for hospice care.
Hospice Care in the Nursing Home
The National Hospice Organization recently published guidelines to help determine the appropriateness of chronically ill patients for hospice care.10 These guidelines generally combine disease-specific information with functional and nutritional measures. Based on the guidelines, an example of an eligible patient would be one who has less than six months to live, who has advanced dementia at stage 7 of the Functional Assessment Staging Scale11 and who has comorbid medical conditions of sufficient severity to have required medical treatment within the past year. In addition, the patient should exhibit all of the following characteristics: inability to ambulate without assistance; inability to dress without assistance; inability to bathe properly; urinary and fecal incontinence, and inability to speak or communicate meaningfully.
Spotlight On… Medicare Hospice Care
A recent OIG report (Medicare Hospices That Focus on Nursing Facility Residents, OEI-02-10-00070) found that hundreds of hospices had more than two-thirds of their beneficiaries residing in nursing facilities in 2009. These “high-percentage hospices” typically served beneficiaries who required less complex care than other beneficiaries but required hospice care for longer periods. By serving beneficiaries for longer periods, these hospices billed Medicare more per beneficiary, on average, which can mean larger profits. The numbers reflect this; compared to the overall pool of hospices, high-percentage hospices are more likely to be for-profit.
MHPS, Title 40, Texas Administrative Code, Chapter 30
(9) The continuous home care request will be denied if documentation is incomplete. Documentation mailed on or before the fifth consecutive day of the crisis period will be reviewed by DHS within 16 work hours of the time the documentation is received in the Long-Term Care Policy Section, at the address identified in paragraph (8)(A) of this subsection. Documentation mailed after the fifth consecutive day will be reviewed by DHS within 10 calendar days of the time the documentation is received in the Long-Term Care Policy Section, at the address identified in paragraph (8)(A) of this subsection. (10) Multiple requests for extensions for the same period of crisis will not be considered. If multiple requests are received, DHS will consider only the first written request. (11) DHS may extend continuous home care if it deems it medically necessary. Providers will be notified in writing of DHS’s decision within the time frames outlined in paragraph (9) of this subsection after DHS’s receipt of the written request and documentation at the address outlined in paragraph (8)(A) of this subsection. DHS will fax the response to the provider if the provider includes a fax number with the extension request. (12) If DHS denies the request for an extension of continuous home care, the provider will be paid at the routine home care rate or inpatient care rate, if applicable, for subsequent days of care. (13) Request for reconsideration. If the provider does not agree with DHS’s denial of the request for an extension of continuous home care, the provider may request a reconsideration of the decision at the state office level. The written request for reconsideration and all supporting documentation must be submitted to DHS at the address in paragraph (8)(A) of this subsection no later than the tenth calendar day after the provider’s receipt of the denial of the request for an extension. DHS’s reconsideration will be limited to a review of the documentation submitted. DHS will complete the reconsideration no later than the tenth calendar day after receipt of the request for reconsideration.
Medicare Coverage of Hospice Care
Medicare Part A will only pay for care provided by a Medicare-certified program and does not allow patients to receive care from more than one hospice program at the same time. That may mean, for example, that a person who was regularly receiving home health care from a specific agency may have to receive it instead from a more complete hospice service that offers the same type of care.