Lawmakers Introduce Bills To Delay Hospice Repayments To Medicare

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Caregivers / Homecare;  Public Health
Article Date: 28 Mar 2008 - 11:00 PDT

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Lawmakers earlier this month introduced bills in the House and Senate that would place a three-year moratorium on retroactive repayments from hospice providers to Medicare and authorize a comprehensive study of Medicare hospice benefits, Scripps Howard/Washington Times reports (Collins, Scripps Howard/Washington Times, 3/27).

The Medicare hospice program originally was designed for people with terminal illnesses who had less than six months to live, as certified by a physician. Nearly all of the patients had cancer and tended to die relatively quickly after health care providers halted curative efforts. However, in the last five years, the use of hospice by patients with less predictable life expectancies, such as those with Alzheimer's disease and dementia, has increased substantially.

According to the Medicare Payment Advisory Commission, the average stay for an Alzheimer's patient is 86 days, compared with 44 days for lung cancer patients. Congress in 1998 removed limits on how long a person could receive Medicare hospice services but did not remove a cap on the aggregate amount that hospices could be reimbursed each year. CMS has begun asking hospices for millions of dollars in repayments from facilities that exceed Medicare reimbursement limits. A recent MedPAC analysis projected that 220 hospices, or about one in every 13 providers, in 2005 received repayment demands totaling $166 million (Kaiser Daily Health Policy Report, 11/27/07).

The National Alliance for Hospice Access began lobbying for the moratorium after hospices began receiving repayment requests. According to Scripps Howard/Times, the repayment notices arrive one to two years after the funds have been used by the provider on salaries, medicines or other supplies, forcing hospices to determine other repayment methods or "face financial ruin" (Scripps Howard/Washington Times, 3/27).

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