hospice in LTC/payment

[ktwlpn, LPN]

I have a question regarding medicare/medicaid and hospice patients in LTC...Our LTC does not consult hospice-we do have a 'comfort care" protocol which is better then nothing but we could do better.The administration has always been against hospice coming in for various reasons but I suspect the real reason is money..Can someone explain how this works in LTC? Does the ltc share the funds with the hospice agency? .. I have heard that if a resident of a medicare certified facility requests true hospice care the facility has to allow it under medicare regs...does anyone know if this is true? Thanks

[aimeee, BSN, RN]

I'll do my best but it can be a bit confusing....

If the patient is currently paying privately for their room and board and is in a basic bed at the nursing home, then not much changes. The patient will continue to pay privately for their room and board, medicare will pay the hospice for their care, and the hospice will pay for medications, DME's, and supplies related to the terminal diagnosis.

If Medicaid is paying for the room and board charges and the patient is in a basic bed then the room and board is paid for via a "pass thru" the hospice. In other words, instead of Medicaid sending the room and board payment to the nursing home, they send it to the hospice, and then the hospice sends it to the nursing home. It works this way whether or not Medicaid or Medicare is the primary pay source. When Medicaid is involved it can get a bit complicated because sometimes the diagnosis coding needs to be adjusted for certain non-related items to get them to continue paying for it once hospice is involved. Also, I think Medicaid only pays the hospice 90% of what they normally pay, believing that when hospice is involved there should be overall savings to the nursing home. Some hospices reimbuse the nursing home this lesser amount, whereas others reimburse the full amount so there won't be a perceived disincentive for the nursing home to refer patients to hospice.

If the patient is in a skilled bed, then usually hospice cannot be involved at all because Medicare/Medicaid will not cover both skilled care and hospice care at the same time unless they are completely non-related, and even then it is an accounting nightmare.

As for requiring them to offer the hospice option....I believe they are required to either offer hospice services OR the equivalent. Medicare requires that there be a contract between the hospice and the nursing home as well but this contract may be either by individual patient or an overall contract. If there are contracts with multiple hospices they are not allowed to dictate to patients that they use one above another, but they are not required to contract with multiple hospices.

[ktwlpn, LPN]

Thanks for your reply-I understand....

[a21chdchic]

In order for a Hospice to enter a long term care facility to see patients, that hospice has to have a contract with the long term care facility, also.

Ana