CMS has been taking comprehensive steps for providing care to its members and patients outside the traditional hospital system. Especially with the COVID-19 outbreak, the American healthcare system is evolving to better accommodate both patients and providers. These steps include flexibility that allows safe hospice home care delivery to patients and provides Ambulatory Surgical Centers (ASCs) for providers to offer better inpatient care when required.

hospice care as the new ma benefit for 2021

The previous action of building expanded availability of telehealth by CMS by offering access all over the nation has enhanced healthcare services to continue with critical care for non-COVID patients. Hence, expanding care delivery services beyond hospital settings that are stemming from PHEs or public health emergencies.

Barriers to access Hospice Care Services before CMS introduced acute inpatient coverage

Before CMS introduced acute inpatient care coverage and Medicare hospice benefits, there were certain barriers in accessing care delivery services. These barriers included:

1 Concerns with funding

The new regulatory flexibilities are devoid of accepting new fundings for plans for these benefits. Researchers and leaders have deciphered that only a small portion of supplemental benefits with the additional new ones can mark as tradeoffs for other potential benefits. These potential benefits include dental, hearing, and wellness programs services which are typically offered by MA plans. A select few MA plans may be capable of paying for added supplemental services depending on Star Ratings and rebates if their bids are considered below benchmark by the CMS in their area.

2 Diminishing contracts with community-based organizations

MA plan leaders cited barriers when discussing contracting with the community-based organizations that offer non-medical supplemental delivery. Such services include meal, transportation, and respite care delivery services. Even though organizations may have the capability to offer such services, doesn’t necessarily mean they have the acute knowledge of partner with insurance plans. Sometimes, these plans cannot partner and contract with other organizations, thus diminishing the chances of covering MA members in the service are.

3 The barrier to access for rural/underserved communities

Rural and underserved communities face a series of obstacles when it comes to accessing care. A reduced workforce, negligible community-based organizations, and long durations in receiving care delivery services or traveling long distances have become a big force of hindrance. Telehealth has been deemed fit to ease these barriers but it has been observed that many rural or underserved areas lack proper broadband bandwidth. Hence, affecting access to care delivery services in a surmountable situation.

Distinguishing Factors of Hospice Care: Background and General Information

When a person is suffering from terminally ill or incurable ailments, and they have exhausted their available options to seek necessary treatments, hospice home care services come to the rescue.

Hospice Home Care: What is it and Who Benefits from it?

Hospice care is designated for people who are suffering from long-term illness or incurable ailments. Hospice home care services are often provided by a group of healthcare professionals whose primary focus is to provide maximum comfort to their patients. By reducing pain, and acknowledging the psychological, spiritual, physical, emotional, and social needs, these professionals enhance support stemming from the comfort of a patient’s home.

This home-based primary care service aids families of terminally ill patients via practical support services, respite care delivery, and offers intense counseling sessions with properly incorporated therapy. The root of hospice care is not based on curing the underlying illness or ailment, but to provide maximum quality of life to the short amount of time that persists.

Home-based hospice care is provided to patients with a duration of fewer than 6 months left to survive. Although, it can be provided as long as the patient’s provider and hospice care team of professionals certify the remaining conditions are limiting to live. People with severe heart problems, dementia, cancer, or chronic pulmonary diseases are eligible to receive Medicare hospice benefit care service.

With the hospice patient aid program, patients can rest assured to have quality care services that can help in better health improvement. It decreases familial burden and prepares them to acknowledge their loved one’s passing. Hospice home care enables patients to receive care at a facility for a short duration of time, providing a break to their family members from the entire situation. This break for the family enables respite care services under hospice aid.

CMS Hollistic Hospice Care Coverage

The CMS hospice care coverage is a comprehensive and holistic aid program changing the focus towards palliative care or comfort care services for terminally ill patients.

Patients and members with Medicare Part A can access hospice care benefits when they meet certain criteria, such as:

  • Receive care delivery from Medicare-certified hospice professionals.
  • When the attending and hospice physician certifies their terminal illness, with the medical prognosis of 6 months or even lesser live if the illness takes its normal course.
  • The beneficiaries sign the election statement, electing hospice benefits, waiving all rights to the Medicare payment.

The patient after being certified can elect their hospice benefits. These include two 90-day periods followed by subsequent 60-day periods. Once the second 90-day period crosses, recertification is connected with the hospice patient’s third period of benefit. Every subsequent recertification has to include documentation about the face-to-face encounter with the hospice practitioner or provider.

The Medicare hospice benefit has several services that assist in pain and illness management depending on the severity of the disease. To manage the terminally ill and their conditions it includes:

  • Patients eligible can choose services for hospice-employed physicians, NPs or nurse practitioners, and other physicians.
  • Medical equipment, medical supplies, nursing care.
  • Drugs and medication to provide relief and pain management.
  • Hospice aide program and homemaker services.
  • Physical, occupational, speech-language pathology therapy, and services.
  • Medical social services.
  • Dietary and spiritual counseling.
  • Individual and family or family grief and loss counseling services.
  • Short-term inpatient symptom management and respite care services.

Key policies to achieve Hospice Care benefits according to CY 2021 VBID

The key policies to achieve hospice home care benefits according to the CY VBID 2021 have included:

  • Access to beneficiaries: Ensuring enhanced access to hospice care for beneficiaries with their eligibility and preference, while addressing short or long concerns. It is also providing access to and the choice of hospice care required to MA enrollees.
  • Payment infrastructure: Enabling stability and sustainability for both MA plan members and hospice providers, while creating innovative opportunities.
  • Quality measures: Tracking, monitoring, and measuring the quality of care MA hospice beneficiaries receive, including appropriate and high-quality care delivery service.
  • Seamless evaluation: Maintaining quality and consistency with CMS Innovation Center’s goals and statutory needs, it is evaluating the impact of the expense and quality model for MA members.
  • Collaborative approaches for hospices and healthcare plans: Considering different and innovative approaches that can help to facilitate the delivery of quality hospice home care services.
Increasing accessibility for housing purposes to senior members with Medicare’s housing benefits

Final Thoughts,

With Rainbow Health’s digitally integrated healthcare solutions, receiving well-integrated hospice care following the statutory CMS guidelines can help your patients build better life-saving services. Hospice home care administers a safe passage for terminally ill and incurable patients with the comfort of treatment and care received at home.

Rainbow Health can enhance the quality of care delivery for your organization, and elevate the care delivery services. With HIPAA compliant approved mobile and web solutions, our digital solutions can enable MA beneficiaries to access proper hospice care in their homes and empower interdisciplinary care teams for better care management and coordination

Hospice care is necessary to provide in-home care and comfort delivery enhancing health longevity

Author's Bio

Ayushi Patel Mobisoft Infotech

Ayushi Patel

Ayushi Patel is the Director of Strategy & Innovation at Mobisoft Infotech. She leads the strategic partnerships and initiatives in the healthcare division. Her experience includes healthcare administration, business development and sales, and customer success management.