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Physician's Role Diminished in Hospice Care by CMS Directive
Date:10/31/2013

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.

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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
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SOURCE National Hospice and Palliative Care Organization
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