Who Pays for Hospice Care?
Hospice care is covered under Medicare and most private insurance plans. Hospice is available under Medicaid in most states. While each hospice has its own policies concerning payment for care, it is a founding principle of hospice to offer services based upon necessity rather than the ability to pay.
Medicare Hospice Benefit
The Social Security Act states that “hospice care” is a list of services provided to a terminally ill individual by a hospice program under a written plan of care for the individual. This plan is established and periodically reviewed by the patients’ attending physician and the medical director, as well as the hospice team.
Services provided:
- Nursing care provided by or under the supervision of a registered professional nurse
- Physical or occupational therapy or speech-language pathology services
- Medical and social services under the direction of a physician
- Services of a home health aide who has successfully completed a training program approved by the secretary and homemaker services
- Medical supplies and the use of medical appliances while under such plan
- Physician’s services
- Short-term inpatient care (both respite and procedures necessary for pain control and acute and chronic symptom management) in an inpatient facility
- Counseling
Any other item or service which is specified in the plan for which payment may otherwise be required
Please visit cms.gov for a thorough explanation of Title 18, Section 1861 (dd) of the Social Security Act.
“Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, an individual must be entitled to Part A of Medicare and be certified as being terminally ill. An individual is considered to be terminally ill if the medical prognosis is that the individual’s life expectancy is six months or less if the illness runs its normal course. Only care provided by (or under arrangements made by) a Medicare certified hospice is covered under the Medicare hospice benefit. The hospice admits a patient only on the recommendation of the medical director in consultation with, or with input from, the patient’s attending physician (if any). In reaching a decision to certify that the patient is terminally ill, the hospice medical director must consider at least the following information: (1) Diagnosis of the terminal condition of the patient. (2) Other health conditions, whether related or unrelated to the terminal condition. (3) Current clinically relevant information supporting all diagnoses.”
-(Source: www.cms.gov)
Please download the Regulations and Guidance manual for extensive Medicare Benefit information and qualifications.
Medicaid and Medicare Hospice Care:
Provides care and comfort in the final months of a patient’s life. A patient is eligible for hospice when a physician certifies them as terminally ill.
This is different from palliative care which is given when diagnosed with a serious illness to help manage pain and symptoms of illness whether terminal or not.
Hospice care is a choice made by the patient and if hospice is chosen, the patient receives help with symptoms and made comfortable.
Receiving Quality Care:
Every patient has the right to quality care, including care that meets all needs and is provided by a trained staff. Choices made by the patient and family members should be respected by the team. If the patient feels they are not receiving quality care, they may call the long-term ombudsman. Information can be found on signs throughout your facility.
Protecting the Medicaid program:
Reporting concerns a patient may have with the program help protect the Medicaid program. Things that do not seem right to patients in regards to information given by the hospice agency should be reported.
To report an issue, click here on the CMS.gov website. You may also contact the U.S. Department of Health and Human Services, Office of Inspector General by email at HHSTips@oig.hhs.gov or by calling 1-800-HHS-TIPS (1-800-447-8477); TTY: 1-800-377-4950.
