Hospice Services in Nursing Homes Often Fall Short
of Medicare Requirements
By Richard Shank
New Department of Health and Human Services (HHS) reports detail the proportion of hospice beneficiaries residing in nursing homes, describe the extent of hospice services provided to them, and monitor hospice compliance with Medicare in nursing homes.
The number of Medicare beneficiaries who receive hospice care in nursing homes has been growing. By 2006, when the latest numbers were made available, nearly one million Medicare beneficiaries received hospice care.
The Tax Equity and Fiscal Responsibility Act of 1982 created benefits for hospice under Medicare Part A. Hospice care is designed to help terminally ill people to continue life with minimal difficulty and provide support for the families of those being cared for. Eligibility requirements for hospice care under Medicare include being entitled to Part A and having a terminal prognosis that includes a life expectancy of six months or less. Accepting care under this aspect of Medicare means that all the remaining care a person receives will be palliative and that Medicare will no longer pay for treatments that are related to the terminal illness; however, Medicare will remain paying for unrelated illnesses.
Using data from National Claims History files, HHS analysts calculated the total number of Medicare beneficiaries, the total number of beneficiaries residing in nursing homes, and the total dollars and the average weekly amount Medicare paid for hospice care. Findings included:
- 31% of Medicare hospice beneficiaries reside in nursing homes.
- On average, $960 per week is spent per hospice beneficiary.
- 82% of nursing home hospice services don’t meet Medicare coverage requirements.
- Nursing homes are often not in compliance across broad areas, including election statements, plans of care, service provision, or certifications of terminal illness.
- 1% of Medicare hospice claims in nursing homes come with no documentation. For example, Medicare requires a detailed plan of care to be submitted for reimbursement. The plan of care helps ensure that those involved in hospice care know precisely “what is supposed to be done, by whom, at what time, and for what purpose.”
- 63% of claims did not meet at least one federal requirement for a plan of care.
- Plans of care were either not established by interdisciplinary groups; they did not include necessary components, such as detailed descriptions of the scope and frequency of services; or they did not specify intervals for review, as required.
With U.S. health care reform looming, it’s unclear if nursing home providers will be under increased scrutiny to provide more accurate information about their hospice care in the future.
See the reports at http://oig.hhs.gov/oei/reports/oei-02-06-00221.pdf and http://oig.hhs.gov/oei/reports/oei-02-06-00223.pdf.
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