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The Medicare
Hospice benefit was initiated in 1982 as part of the Tax Equity
and Fiscal Responsibility Act. The benefit was designed to save
Medicare dollars while improving end-of-life care. Savings would
arise because people could choose lower-cost palliative care over
high-cost care that was likely to be ineffective-such as stays
in the intensive care unit. Beneficiaries were given the chance
to elect hospice care in exchange for their usual Medicare benefits.
Medicare comprehensive
hospice care includes some standard services and many services
that are not a routine part of the Medicare benefit. All are offered
with no deductible and no or minimal co-payments:
- Physician
Services;
- Nursing
Care;
- Medical
Equipment (e.g. wheelchairs and walkers);
- Medical
Supplies (e.g. bandages and supplies);
- Drugs for
symptom control and pain relief;
- Short term
care in hospital, including respite care;
- Home health
aide and homemaker services;
- Physical
and occupational therapy;
- Speech
therapy;
- Social
worker services;
- Dietary
counseling; and
- Counseling
to help the patient and the patient's family with grief and
loss.
The requirements
for hospice entry are:
- Enrolled
in Medicare
Part A;
- Certification
by the patient's physician and the hospice medical director
that the patient has a terminal illness and is expected to live
6 months or less if the illness runs its typical course;
- Consent
to receive hospice care instead of other routinely covered Medicare
benefits; and
- Care must
be received in a Medicare-approved hospice program.
Patient agrees
to waive all rights to the following services:
- Any Medicare
services that are related to the treatment of the terminal condition
for which hospice care was elected or a related condition; and
- Hospice
care provided a facility other than the hospice designated by
the patient or provided by a physician other than the designated
attending physician.
Note that
hospice enrollment does not require that the patient have specific
symptoms or care needs.
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