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Bills To Delay Hospice Repayments To Medicare

Armen Hareyan's picture

Lawmakersearlier this month introduced bills in the House and Senate that would place athree-year moratorium on retroactive repayments from hospice providers toMedicare and authorize a comprehensive study of Medicare hospice benefits, ScrippsHoward/Washington Times reports (Collins, ScrippsHoward/Washington Times, 3/27).

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

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According to the Medicare Payment Advisory Commission, the average stay for anAlzheimer'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 Medicarehospice services but did not remove a cap on the aggregate amount that hospicescould be reimbursed each year. CMS has begun asking hospices formillions of dollars in repayments from facilities that exceed Medicarereimbursement limits. A recent MedPAC analysis projected that 220 hospices, orabout one in every 13 providers, in 2005 received repayment demands totaling$166 million (Kaiser Daily Health PolicyReport, 11/27/07).

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

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.