Narrative may be required for future Medicare coverage of hospice care

Are you ready to write? You may need to be if you want Medicare to cover hospice care.

On April 21, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to update the Medicare Hospice Wage Index for fiscal year (FY) 2010. In addition to the anticipated cut in hospice reimbursement rates, the proposed rule would require physicians to write a short narrative describing the patient’s clinical condition for Medicare coverage of hospice care. This requirement would take effect in FY 2010.

Current policy requires the hospice medical director or physician member of the interdisciplinary group and the patient’s attending physician (if any) to certify the patient as having a terminal illness for the initial 90-day period of hospice care. Subsequent benefit periods only require recertification by the hospice medical director or by the physician member of the interdisciplinary group.

The Medicare Payment Advisory Commission (MedPAC) noted an increasing proportion of hospice patients with stays exceeding 180 days. It also noted significant variation in hospice length of stay and recommended increased accountability and enforcement related to certification and recertification of Medicare hospice patients.

In response to this recommendation, CMS is proposing a rule change requiring physicians that certify or recertify hospice patients as being terminally ill include a brief narrative explanation of the clinical findings that support a life expectancy of six months or less. The brief narrative should be written or typed on the certification form itself. CMS is seeking comments as to whether this proposed requirement would increase physician engagement in the certification and recertification process.

The proposed rule also seeks comments on a number of potential policy changes (e.g., payment reform, requirement that a physician or nurse practitioner visit every hospice patient after 180 days of receiving the benefit and every benefit period thereafter). Comments on the proposed rule will be accepted until 5 p.m. on June 22 and may be submitted electronically.

Click here to view a copy of proposed rule that was published in the Federal Register on April 24. To view a fact sheet on the proposed rule, click here.