Hospice care involves medical treatment of the terminally ill individual and the provision of supportive and bereavement services to the patient and the patient’s caregivers.
According to the Medicare Payment Advisory Commission, “Medicare began offering the hospice benefit in 1983, pursuant to the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). The benefit covers palliative and support services for beneficiaries who are terminally ill, with a medical prognosis indicating that the individual’s life expectancy is six months or less if the illness runs its normal course. A broad set of services is included, such as nursing care; physician services; counseling and social worker services; hospice aide (also referred to as home health aide) and homemaker services; short-term hospice inpatient care (including respite care); drugs and biologics for symptom control; supplies; home medical equipment; physical, occupational, and speech therapy; bereavement services for the patient’s family; and other services for palliation of the terminal illness and related conditions. Most commonly, hospice care is provided in patients’ homes, but hospice services are also provided in nursing facilities, assisted living facilities, hospice facilities, and hospitals. In 2019, more than 1.6 million Medicare beneficiaries received hospice services from approximately 4,840 certified providers, and Medicare expenditures totaled about $20.9 billion.
“Medicare is the largest payer of hospice services, covering about 90 percent of hospice patient days in 2017. Payments are made according to a fee schedule that has four levels of care: routine home care (RHC), continuous home care (CHC), inpatient respite care (IRC), and general inpatient care (GIP). The four levels are distinguished by the location and intensity of the services provided. RHC is the most common level of hospice care, accounting for about 98 percent of Medicare-covered hospice days in 2018…GIP is provided in a facility on a short-term basis to manage symptoms that cannot be managed in another setting. CHC is intended to manage a short-term symptom crisis in the home and involves eight or more hours of care per day, mostly nursing. IRC is care in a facility for up to five days to provide a break for an informal caregiver….Daily payment rates for hospice are adjusted to account for geographic differences in wage rates.”