Medicare Hospice Respite Benefit. MATRIX Components: Medicare Hospice Respite Benefit

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Belinda Wilkerson
7 years ago
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1 MATRIX Components: Medicare Hospice Respite Benefit Definition of Respite: Respite care is temporary care provided in a nursing home, hospice inpatient facility, or hospital given to a hospice patient by a caregiver so that a family member or friend who is the patient s caregiver can rest or take time off. Criteria for Service: To be eligible for Medicare hospice respite benefit, patient s must meet all of the following conditions: Eligible for Medicare Part A (Hospital Insurance). Doctor and the hospice medical director certify that a patient is terminally ill and has 6 months or less to live if the illness runs its normal course. Person signs a statement choosing hospice care instead of other Medicare-covered benefits to treat their terminal illness. (Medicare will still pay for covered benefits for any health problems that are not related to the terminal illness.) Person receives care from a Medicare-approved hospice program. Primary Funding Source(s): Medicare pays the hospice provider for hospice care. There is no deductible. Client/participant financial responsibilities: Patients who require inpatient respite care pay 5 percent of the Medicare-approved amount. Patients pay no more than $5.00 for each prescription drug and other 1

2 similar products for pain relief and symptom control. Services/activities funded: Medicare covers a one-time only consultation with a hospice medical director or hospice doctor to discuss a patient s care options and pain and symptoms management. The following services are covered by Medicare: Doctor services Nursing care Medical equipment (such as wheelchairs or walkers) Medical supplies (such as bandages and catheters) Drugs for symptom control or pain relief (may need to pay a small copayment) Hospice aide and homemaker services Physical and occupational therapy Speech-language pathology services Social worker services Dietary counseling Grief and loss counseling for you and your family Short-term inpatient care (for pain and symptom management) Short-term respite care (may need to pay a small copayment) Any other Medicare-covered services needed to manage your pain and other symptoms related to your terminal illness, as recommended by your hospice team Services/activities excluded: The following services are NOT covered by Medicare: Treatment intended to cure the terminal illness Hospice patients always have the right to stop hospice care at any time. 2

3 Prescription drugs to cure the illness (rather than for symptom control or pain relief) Care from any hospice provider that was not set up by the hospice medical team: Hospice care must be received from a hospice provider. All care for a terminal illness must be given by or arranged by the hospice team. The person cannot get the same type of hospice care from a different provider, unless they change hospice provider. However, the person can still see his/her regular doctor if they have chosen him/her to be the attending medical professional who helps supervise hospice care. Room and board Medicare does not cover room and board if hospice care is provided in the home or if the person lives in a nursing home or a hospice inpatient facility. However, if the hospice team determines that the person needs short-term inpatient or respite care services that they arrange, Medicare will cover the stay in the facility. The individual may have to pay a small copayment for the respite stay. Care in an emergency room, inpatient facility care, or ambulance transportation, unless it is either arranged by the hospice team or is unrelated to the terminal illness. Emergency Respite available: For emergency respite, caregivers are encouraged to contact their local Medicare-approved hospice agency. Medicare provides a toll-free to answer frequently asked questions, including information about the status of a person s Medicare coverage and referrals to locally based respite care. Web-based access to services: To locate a hospice program, one can contact the following: National Hospice & Palliative Care Organization( NHPCO) at Hospice Association of America: 3

4 Official Medicare website: Call MEDICARE ( ). TTY users should call Gaps: Medicare claims that respite care should be provided occasionally, but offers no definition to occasionally. Also, according to Medicare, a patient can get inpatient respite care for up to 5 days at a time. What happens when a family may require additional days? Still, there remains a great deal of confusion concerning how long a patient can receive respite care. Other comments: Respite care is a sub-component of the hospice benefit under Medicare. In addressing care for a condition other than a patient s terminal illness: a patient should continue to use Original Medicare to get care for any health care needs that are not related to his/her terminal illness. A patient can get inpatient respite care for up to 5 days at a time. A patient has the right to change hospice providers once per benefit period; however, the newly chosen hospice program must also be Medicare-certified. 4

5 Terms: Medicare-approved amount: In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. This amount may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and patient is responsible for the difference. Original Medicare: Original Medicare is fee-for-service coverage under which the government pays your health care providers directly for Part A and/or part B benefits. Prepared by Concessa Alfred, Intern, NYS Office for the Aging MSW candidate, School of Social Welfare, University at Albany Supervised by Jennifer Rosenbaum, NYSOFA For the Lifespan Respite Initiative January,

Medicare Hospice Benefits

CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare Hospice Benefits This official government booklet includes information about Medicare hospice benefits: Who is eligible for hospice care What services