Title: Fast Fact and Concept #82: Medicare Hospice Benefit Part I: Eligibility and Treatment Plan
Author(s): Robin Turner, MD
In the United States, the Medicare Hospice Benefit (MHB) pays for 80% of all hospice care. Established in 1983, the MHB pays for medical, nursing, counseling and bereavement services to terminally ill patients and their families. The original goal of the MHB was to support families caring for their dying relative at home. Under certain circumstances, hospice services under the MHB can also be provided in a nursing home or the acute care hospital. Referral for hospice care is appropriate when the overall plan of care is directed toward comfort rather than reversing the underlying disease process.
Eligibility-Medicare Hospice Benefit
Covered Services (100% coverage with no co-pay)
Plan of Care (POC)
The hospice team and the patient's physician work together to maximize quality of life by jointly developing the Plan of Care. The POC is based on the patient's diagnosis, symptoms and other needs. The hospice program and the patient's physician must together approve any proposed tests, treatments and services. In general, only those treatments that are necessary for palliation and/or management of the terminal illness will be approved.
At the time of enrollment the patient indicates the primary physician who will direct care; the patient may select a hospice physician for this role or may select their usual primary doctor. The primary physician is responsible for working with the hospice team to determine appropriate care.
Fast Fact #87, Medicare Hospice Benefit Part II: Places of Care and Funding
Fast Fact #90, Medicare Hospice Benefit Part III: Special Interventions
Centers for Medicare & Medicaid Services. Hospice Manual Chapter II-Coverage of Services.[Online] Available http://cms.hhs.gov/manuals/21_hospice/hs200.asp. October 11, 2002.
Gretchen M. Brown, Connie A. Raffa, JD, LLM & Susan Swinford, BSW, MSW. How to Fund Your Palliative Care Program Concurrent Session D Part 1.PowerPoint Presentation. [Online] Available http://www.capcmssm.org/content/203/index/html. October 21, 2002.
Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Facts and Concepts #82 . Medicare Hospice Benefit Part 1. Turner, R. January 2003. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.
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Creation Date: 1/2003
Purpose: Instructional Aid, Self-Study Guide, Teaching
|Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice|
|Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery|
|Non-Physician: Clergy/Chaplains, General Public, Graduate Students, Lawyers, Patients/Families, Nurses, Social Workers|
ACGME Competencies: System-based Practice
Keyword(s): Caring for families, Home care benefit, Medicare hospice benefit, Post-death family care, Quality of life, Spirituality
The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).