HOSPICE: DeParle Says Care Not Limited by Six-Month Rule
Hospice beneficiaries are "in no way" restricted to six months of coverage by Medicare, HCFA Administrator Nancy-Ann Min DeParle writes in a "strongly worded letter" being sent to 2,200 hospices this week. DeParle said she wants to counter the "disturbing misperception" that federal guidelines -- which require a patient to have physician certification of being likely to die within six months in order to receive Medicare support for hospice care -- mean that patients who outlive the "narrow reimbursement timeline" risk losing their coverage and could face severe financial penalties. "Nothing can be further from the truth," she said. In her letter, DeParle also proposed a pilot program in which hospices would be able to obtain pre-authorization from Medicare contractors to offer care to patients whose "prognosis is difficult" and who might outlive the six-month requirement for Medicare coverage. Such exemptions would "preempt 'concerns about denial of claims' and therefore encourage 'earlier enrollment for more beneficiaries,'" the Wall Street Journal reports. Some critics say, however, that the "time-dependent" eligibility criteria should be eliminated altogether, noting that new treatments for diseases such as AIDS and cancer make predicting death difficult. A HCFA spokesman said that the agency doesn't "see a need for a fundamental legislative change," but that the proposed pre-authorization program should provide "some comfort."
The Plattsburgh Case
DeParle's letter comes just a few months after a front-page story in the Wall Street Journal described how the "little Hospice of the North County" in Plattsburgh, N.Y., had been "hit with a large Medicare bill because some of its patients had lived far beyond six months." The hospice disputed the $450,000 charge in court, where a judge not only found in the hospice's favor but also "chided the government," calling the fact that some patients outlived the six-month timeline "an achievement ... not an indicia of fraud." Despite the victory, several other hospices said they have been "subjected to rigorous audits by Medicare contractors," leading to a relationship with HCFA and its contractors that is rife with "bitterness and suspicion" (Lagnado, 9/15).