Hospice payments to rise slightly under CMS proposal

The Centers for Medicare & Medicaid Services proposed a modest bump in payments for hospice providers, but the agency also wants to limit dispensing prescriptions to reduce unnecessary and pricey duplications.

A proposed rule from CMS issued late last week would increase hospice payments by a total of $230 million, or 1.3 percent, in fiscal 2015. The rule also calls for hospices to improve their quality reporting, which the agency estimates will cost the sector about $8.8 million to implement.

Hospice care experienced rapid growth in recent years, as terminally ill patients wish to die at home or in a setting more palatable than a hospital. And such care tends to be less expensive and comforting to the patient than acute care.

The proposal, which will likely go into effect later this year after a public comment period, comes as CMS also tries to tighten up how it pays for drugs in the hospice setting.

On May 1, the agency instituted guidance that prohibits Medicare Part D insurers from paying for any drugs for hospice patients unless they receive prior confirmation that the hospice is not already covering them, Kaiser Health News reported. Hospices must cover drugs related to palliative care, while Part D must cover drugs related to hospice patients' non-terminal conditions.

However, Part D insurers may have paid as much as $33 million for drugs that hospices should have covered, with hospice patients also spending millions of dollars in co-payments, according to KHN. Under the new rule, hospice patients would initially receive a denial for coverage of their prescription requests until the hospice and the insurer works out coverage responsibilities.

Implementation of the rule began in some regions of the country earlier this year, and as a result, some patients initially underwent hospice care without palliative drugs.

"We had a couple of patients who went in to get their cardiac medications and were denied," Susan Strauss, chief compliance officer at Hope Health, Inc., in Hyannis, Massachusetts, told KHN. "Denying people cardiac meds--or the medication they need to breathe easier--that they have had for 30 years and are unrelated to their hospice diagnosis is causing them more pain, more anxiety and puts them at greater risk for more emergency room visits and hospitalizations."

To learn more:
- here's the Kaiser Health News article
- check out the proposed rule (.pdf)

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