MEDICARE RULE FORMALIZES HOSPICE PATIENTS’ RIGHTS
A new Medicare regulation, to take effect December 2, 2008, sets out a detailed list of hospice patients’ rights, including the right to participate in treatment planning, the right to refuse treatment, the right to choose one’s own doctor, and the right to receive effective pain control. Although many hospice patients are already active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights.
Under the regulation, hospices must meet new quality of care standards to receive Medicare payments. The regulation requires better care coordination through service delivery, quality assessment and performance improvement, and focus on patient-centered care. This includes making counseling services available to family members, as well as bereavement counseling for up to one year after the patient’s death.
Additionally, hospices are required to implement an outcome-oriented quality assessment. This assessment must identify the physical, psychosocial, emotional and spiritual needs of the hospice patient, to ensure the person’s well-being, comfort and dignity throughout the dying process.
This is the first overhaul of hospice regulations since 1983 and was informed by a hospice survey conducted by CMS, as well as advice from those working within the hospice industry, including practitioners, professional associations and consumer advocacy groups.
In addition to the new patient rights’ section, final regulation also includes:
- A requirement that patient needs be initially assessed within 48 hours of electing the hospice benefit. The rule also requires that a comprehensive assessment occur within five days of electing the hospice and that updated assessments be done at least every 15 days thereafter.
- A requirement that each patient receive a full drug profile that examines issues ranging from the effectiveness of current drug therapies to potential drug interactions to drug side effects. A treatment team will consult with a qualified individual, such as a pharmacist, to ensure that drugs meet the needs of every hospice patient.
- A provision allowing a hospice to contract with another Medicare-certified hospice for nursing, medical social services, and counseling services under extraordinary or other non-routine circumstances, including travel of a patient outside of the hospice’s service area.
- Removal of a provision requiring an inpatient facility only providing respite care to have an RN on duty 24 hours a day. The patient’s needs, acuity and plan of care will drive the nursing and staffing requirements.
The regulation, to be in the Federal Register on June 5, can be viewed at www.cms.hhs.gov/CFCsAndCoPs/05_Hospice.asp
-Adapted from: MEDICARE WATCH , a biweekly electronic newsletter of the Medicare Rights Center, Vol. 11, No. 13: June 24, 2008 and CMS press release “ CMS Outlines Rights Of Medicare Hospice Patients” retrieved 6/25/08 from http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3144.
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