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Physician's Role Diminished in Hospice Care by CMS Directive

ALEXANDRIA, Va., Oct. 31, 2013 /PRNewswire-USNewswire/ -- Today, the Centers for Medicare and Medicaid Services released a directive to Part D plan sponsors called "Clarification on Recovery of Part D Payment for Pain Medications for Beneficiaries Enrolled in Hospice".  What does this mean? In cases where the patient was enrolled in hospice and Part D, and the prescription drugs were paid for by Part D, CMS is directing plans to take back funds from hospices for patients' pain control medicines in 2011 and 2012.  For this payment recovery effort, CMS presumes that ALL pain medications "were used for the palliation and management of terminal illness and/or related conditions."  It is the National Hospice & Palliative Care Organization's position that this is not true.


Although the vast majority of pain medications prescribed to hospice patients are related to the terminal condition, it is simply false to presume that all are.  It is a dangerous precedent to presuppose that all analgesics ARE related to the terminal illness, without the voice of the hospice physician, who has patient-specific knowledge, and who is responsible for deciding whether a drug is related to the terminal illness or not.

"We are outraged that CMS would disregard the law and their own regulations to de-emphasize the role of the hospice physician in determining what care is required as part of the patient's terminal condition," said J. Donald Schumacher, NHPCO president and CEO.  "Thirty years of hospice statute and regulations  clearly  contradicts any attempt to recoup payments for any portion of the patient's plan of care without first determining if the care, in this case pain medication, was deemed related to the terminal condition by a physician."

In recent weeks, NHPCO has been working with CMS to try and sort out previous memoranda to Part D sponsors regarding the intersection of the Medicare Hospice Benefit and Part D Coverage.  The hospice community has also raised concerns about previous directives, and is alarmed by the fact that all communication from CMS has been directed to Part D plan sponsors, and not to hospice providers who will be impacted.

"Hospices absorb the costs for all care related to a patient's terminal condition, whether it be medication, DME, direct care from all members of the interdisciplinary team and anything necessary for the palliation of pain and management of symptoms.  We are not debating this in any way.  Since we were made aware of this issue, we have repeatedly asked for CMS to convene all of the impacted stakeholders – the hospice community, Part D sponsors, and pharmacies – to create a plan for ensuring that the proper entity is paying for the care of hospice patients.  Instead, for the sake of "administrative ease", CMS has moved forward with this guidance a truly careless and reckless manner," said Schumacher.

Jonathan Keyserling
NHPCO Senior Vice President, Health Policy
Ph: 703-837-3153

SOURCE National Hospice and Palliative Care Organization
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