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Medicare Modifies Controversial Hospice Drug Rule (won't pay for pain relief pills)
Washington Post ^ | July 18, 2014 | Susan Jaffe

Posted on 07/19/2014 2:49:07 AM PDT by Innovative

Under the rules that took effect in May, hospice patients or their families could not fill prescriptions through their Part D drug plans until first confirming that the prescriptions were not covered by hospice providers. Drugs related to palliative and comfort care are supposed to be covered under the fixed rate payments to the hospice.

Medicare announced Friday that the rules would be revised so that the additional authorization would be required for only four types of medications: pain relievers, anti-nauseants, laxatives, and anti-anxiety drugs that are “nearly always” considered hospice-related.

(Excerpt) Read more at washingtonpost.com ...


TOPICS: Culture/Society; Extended News; Government; News/Current Events
KEYWORDS: hospice; medical; medicalcare; medicare; medicaredrugs; medications; nursinghome; obamacare; obamacaredrugs; painmeds; prescriptiondrugs
More impact of Obamacare. Now hospices are supposed to pay for patients' pain relievers out of their fixed fee -- you know how much pain relief patients are going to get!

People in hospices are at the end of their life and all they can hope for is to be reasonably comfortable and pain free.

And now Obamacare is denying them even that.

As the article was written, it seems that the original rule -- before they changed it -- was for the hospice to provide ALL the patients' medication out of their own pocket, instead of Medicare paying for it.

1 posted on 07/19/2014 2:49:08 AM PDT by Innovative
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To: Innovative

Sarah Palin was right — once people are in a hospice, Medicare doesn’t want to pay for anything, let them die, the sooner the better...

In the article it said that the original rule was that Medicare wasn’t going to pay for any medications, let the hospice pick it ups — even such medications to treat pulmonary problems, etc.

“Generously”” “Medicare generally pays drugs for diabetes, heart disease or other chronic conditions still used by hospice patients but not directly related to their terminal illness.”

IOW they don’t want to pay to help say a cancer patient’s cancer meds — once you get ill, they want you to die sooner, rather than later and not even be comfortable.

People didn’t believe how horrible Obamacare is, and this is just the beginning...


2 posted on 07/19/2014 2:55:43 AM PDT by Innovative ("Winning isn't everything, it's the only thing." -- Vince Lombardi)
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To: Innovative; SgtBob; Chode
Well now this explains why the MIL suddenly was “Ineligible” for ChampVA refills last month!

I gave up after 2 days on the phone hand off game and contacted Our House/Senate offices and got them to fix it- still took 2 + weeks.

3 posted on 07/19/2014 2:58:43 AM PDT by mabarker1 (Please, Somebody Impeach the kenyan!!!! Once again dingy hairball, STFU!!! You corrupt POS!!!)
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To: mabarker1

Welcome to Obamacare...


4 posted on 07/19/2014 3:05:01 AM PDT by Innovative ("Winning isn't everything, it's the only thing." -- Vince Lombardi)
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To: Innovative

Maybe I’m misinterpreting the article but this seems like a correction to me. Isn’t this to prevent the patient from having to pay a copay out of their pocket for drugs that should be covered under their Medicare hospice benefit?

I’ve worked with many hospice patients and in my opinion they were very free with the pain killers. In fact, I’ve observed what I considered to be euthanasia with morphine several times.


5 posted on 07/19/2014 3:29:23 AM PDT by Wage Slave
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To: Innovative

But they said I could keep my doc!

Can’t use ‘em but I can keep ‘em...


6 posted on 07/19/2014 4:02:53 AM PDT by mabarker1 (Please, Somebody Impeach the kenyan!!!! Once again dingy hairball, STFU!!! You corrupt POS!!!)
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To: Wage Slave

yep...... I concur from direct observation


7 posted on 07/19/2014 4:09:38 AM PDT by bert ((K.E.; N.P.; GOPc.;+12 ..... Obama is public enemy #1)
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To: Innovative

So Obama lied again. Five years ago he said the elderly should get pain pills rather than treatments for their underlying conditions. Now he wants to cut their pain medications.


8 posted on 07/19/2014 4:28:34 AM PDT by Paleo Conservative (Just because you're paranoid doesn't mean they're not really out to get you.)
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To: Wage Slave; bert
They are not worrying about patients' co-pay - Medicare won't pay for it, to save money -- they want to push the cost of the medicines to the hospice care. Apparently the initial mandate was so outrageous that Medicare wasn't going to pay for ANY medication for those in nursing homes, now they "relaxed" the rules that now they will pay for medications related to the specific illness but NOT for palliative care.

Do you prefer that patients scream in pain? We are talking about people who have a few months to live.

"Medicare generally pays drugs for diabetes, heart disease or other chronic conditions still used by hospice patients but not directly related to their terminal illness"

9 posted on 07/19/2014 4:39:05 AM PDT by Innovative ("Winning isn't everything, it's the only thing." -- Vince Lombardi)
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To: Paleo Conservative

Who is pushing Granma off the cliff?!

Remember the ad that the Dems ran against a Republican (I forgot who), showing him literally pushing Granma off a cliff in a wheelchair.

When in fact Obamacare is basically denying terminally ill patients even their comfort in their last days.


10 posted on 07/19/2014 4:42:17 AM PDT by Innovative ("Winning isn't everything, it's the only thing." -- Vince Lombardi)
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To: Innovative

This article is confusing. At one time, the medicare hospice benefit paid a per diem rate to the provider. The provider was in essence, capitated. The provider was to “live” under the per diem and effectively assume all aspects of care. Capitation was once described as “that’s when they cut your head off.”


11 posted on 07/19/2014 4:48:17 AM PDT by Artie (We are surrounded by MORONS)
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To: Wage Slave; bert; Paleo Conservative
After your comments I did more research -- went to some of the links given in the article.

I found:

"Instead of leaving it to insurers and hospice providers to identify the drugs they are responsible for, the new rule sets up a process that requires Part D plans to reject initially any prescription from a hospice patient. The patient or doctor, with the hospice provider’s agreement, must explain to the insurer why the drug is not related to end-of-life care. The insurer may deny coverage for a number of reasons, including if the doctor or hospice did not explain sufficiently why the drug was unrelated to the terminal illness, Medicare officials told hospice organizations and insurers"

Medicare Seeks To Stop Overpayments For Hospice Patients' Drugs

May 1, 2014

http://www.kaiserhealthnews.org/stories/2014/may/01/new-medicare-procedures-seek-to-stop-overpayment-of-drugs-for-hospice-patients.aspx

12 posted on 07/19/2014 4:48:26 AM PDT by Innovative ("Winning isn't everything, it's the only thing." -- Vince Lombardi)
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To: Artie

Yes, it is really bad — please see my post 12 with some additional info I found.

Basically they want the nursing home to pay for all the meds out of their pocket.


13 posted on 07/19/2014 4:49:39 AM PDT by Innovative ("Winning isn't everything, it's the only thing." -- Vince Lombardi)
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To: Innovative

I read the article again and I see even more clearly that this is a sensible correction.

I have been a nurse for almost 30 years and have cared for many hospice patients; I have worked closely with the hospice organizations that care for them while they are in our facility and am familiar with the regulations for coverage of meds. All meds directly related to their hospice diagnosis, including pain meds, have always been covered under their hospice benefit and will continue to be covered. Those meds that are not part of their hospice diagnosis were never intended to be covered by the hospice benefit.

They will need further authorization if they want their non-hospice medicare coverage to pay for these drugs that are already covered under the hospice benefit.


14 posted on 07/19/2014 4:52:07 AM PDT by Wage Slave
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To: Innovative

Hey ya know Grandma would be better off coughing up and paying for a painkiller!

http://www.youtube.com/watch?v=U-dQfb8WQvo


15 posted on 07/19/2014 4:52:33 AM PDT by Rock N Jones
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To: Rock N Jones

Keep reading — see my post 12 and the article from which I excerpted — they don’t want to pay for ANY medications for patients in nursing homes, let the nursing home pay for it, which means either that they will lose money or will not be able to provide the meds to the patients, because Medicare has fixed reimbursements to the nursing homes.


16 posted on 07/19/2014 4:54:56 AM PDT by Innovative ("Winning isn't everything, it's the only thing." -- Vince Lombardi)
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To: Innovative
In Great Britain, people who have no family members to speak up for them are shuttered in the far reaches of a hospice or hospital and not fed or given pain relief. They are expected to die on their own and out of sight and usually do die excruciating deaths alone just because it costs too much to take care of them. Everyone in Great Britain knows this as a reality of their National Health Service. People work to opt for private care if they can afford it. But, those without vocal family members or money are up $#!+ Creek.

This is the slippery slope Sarah Palin warned us about and is already in operation in a country used as an example of what the libs want for us.

17 posted on 07/19/2014 5:36:34 AM PDT by Slyfox (When progressives ignore moral parameters, they also lose the natural gift of common sense.)
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To: Innovative

Related article with more info:

U.S. Medicare program scales back hospice drugs restrictions

http://www.freerepublic.com/focus/f-news/3182342/posts


18 posted on 07/19/2014 5:38:18 AM PDT by Innovative ("Winning isn't everything, it's the only thing." -- Vince Lombardi)
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To: Innovative; Wage Slave
One needs to 1) read the article, and 2) understand Medicare (Parts A, B, and D), long-term care (nursing homes), and what hospice is before you jumping to conclusions.

First, what happened was restrictions on hospice patients' Medicare Part D prescriptions were decreased, not increased.

Second, Medicare Part A (hospitalization) is what pays for hospice services.

What does Medicare Part A cover?

Medicare does not pay for long-term care. The only nursing home care Medicare pays for is rehabilitative care. This article has little to do with nursing homes. There is no way someone would be in a Medicare paid for nursing home while on Medicare paid for hospice. However, someone could be in a self-paid or Medicaid paid long-term care facility and require hospice care.

Hospice providers are not the same thing as nursing homes. Someone in a long-term care who is a hospice patient gets their hospice services from a hospice provider. Hospice providers are regulated differently from hospitals and long-term care faciliites That hospice provider may be a subsidiary of the long-term care facility, or it may be separate.

When you are in the hospital, Medicare Part A (not Part D) pays for any prescription drug you get while in the hospital. With hospice, it works the same (both for outpatient hospice and inpatient hospice). The hospice provider bills Medicare for hospice services, which included palliative drugs. Like hospitals, most hospice providers have their own pharmacies which provide these drugs.

Given the level of narcotics used by hospice, I don't think you could even get those from your local CVS using Medicare Part D.

Hospice is end of life care. Once you go into hospice, you are stopping treatment of underlying diseases. Once one chooses for Medicare to pay for their hospice services, Medicare stops paying for curative services.

Hospice & respite care

What appears to have been happening here is some hospice providers were billing Part D for hospice drugs (defined by Medicare). By law, Part D cannot pay for drugs which are paid for by Part A or Part B.

Medicare does limit hospice reimbursement to a certain daily amount, and all palliative drugs come out of that payment. But that is way hospice works under Medicare.

Second, if you are in hospice, you have little need for drugs you would get via Part D, because curative care is discontinued in hospice. Medications for chronic conditions (blood pressure, cholesterol, diabetes) generally stop, unless stopping those drugs would cause pain or discomfort. So something tells me these are corner cases.

The parenthetical comment, Medicare "won't pay for pain relief pills" is completely wrong. Pain medications are palliative and are covered by Part A for hospice patients.

19 posted on 07/19/2014 6:09:40 AM PDT by magellan
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To: magellan

As I said, need to read the articles.

You say:

“First, what happened was restrictions on hospice patients’ Medicare Part D prescriptions were decreased, not increased. “

Yes, AFTER the restrictions were INCREASED.

See my post 12:

“Instead of leaving it to insurers and hospice providers to identify the drugs they are responsible for, the new rule sets up a process that requires Part D plans to reject initially any prescription from a hospice patient. The patient or doctor, with the hospice provider’s agreement, must explain to the insurer why the drug is not related to end-of-life care. The insurer may deny coverage for a number of reasons, including if the doctor or hospice did not explain sufficiently why the drug was unrelated to the terminal illness, Medicare officials told hospice organizations and insurers”

Medicare Seeks To Stop Overpayments For Hospice Patients’ Drugs

May 1, 2014

http://www.kaiserhealthnews.org/stories/2014/may/01/new-medicare-procedures-seek-to-stop-overpayment-of-drugs-for-hospice-patients.aspx


20 posted on 07/19/2014 6:17:26 AM PDT by Innovative ("Winning isn't everything, it's the only thing." -- Vince Lombardi)
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To: mabarker1
and it's only gonna get worse
21 posted on 07/19/2014 6:48:10 AM PDT by Chode (Stand UP and Be Counted, or line up and be numbered - *DTOM* -vvv- NO Pity for the LAZY - 86-44)
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To: magellan
I am an out patient hospice patient. You are absolutely right. There is plenty of wrong with Medicare, but hospice is done right. I have been on hospice for 9 months and have had excellent care,
22 posted on 07/19/2014 7:57:31 AM PDT by Coldwater Creek
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To: Innovative

Paging Dr Mengele...Dr Mengele...


23 posted on 07/19/2014 10:26:31 AM PDT by hal ogen (First Amendment or Reeducation Camp?)
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