Adapted from CMS guidelines Aug 2013 for Ambercare Corporation Education Department 2014

Hospice helps people who are terminally ill live comfortably Hospice isn’t only for people with cancer The focus is on COMFORT MEASURE CARE, NOT curing illness A specially trained team of professionals and caregivers provide care for the “whole person”, including his or her physical, emotional, social, and spiritual needs Services may include: physical care, counseling, medications, equipment and supplies for the terminal illness and related condition(s) Care is generally provided in the home (can be an Assisted Living, Nursing home facility or a Residential care facility) Family caregivers can also receive support Hospice helps people who are terminally ill live comfortably Hospice isn’t only for people with cancer The focus is on COMFORT MEASURE CARE, NOT curing illness A specially trained team of professionals and caregivers provide care for the “whole person”, including his or her physical, emotional, social, and spiritual needs Services may include: physical care, counseling, medications, equipment and supplies for the terminal illness and related condition(s) Care is generally provided in the home (can be an Assisted Living, Nursing home facility or a Residential care facility) Family caregivers can also receive support What is Hospice?

If you are eligible for Medicare Part A (Hospital Insurance) Your doctor and the hospice medical director certify that you are terminally ill and have 6 months or less to live if your illness runs its normal course You sign a statement choosing hospice care instead of other Medicare- covered benefits to treat your terminal illness (Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness) You get care from a Medicare-approved hospice program If you are eligible for Medicare Part A (Hospital Insurance) Your doctor and the hospice medical director certify that you are terminally ill and have 6 months or less to live if your illness runs its normal course You sign a statement choosing hospice care instead of other Medicare- covered benefits to treat your terminal illness (Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness) You get care from a Medicare-approved hospice program The Medicare Hospice Benefit – who qualifies?

Each patient is assigned a specially trained team and support staff available to help patient and family cope with the illness Team members may include: Doctors Nurses or nurse practitioners Counselors (chaplain) Social workers Physical and occupational therapists Speech-language pathologist Hospice aide Volunteers Each patient is assigned a specially trained team and support staff available to help patient and family cope with the illness Team members may include: Doctors Nurses or nurse practitioners Counselors (chaplain) Social workers Physical and occupational therapists Speech-language pathologist Hospice aide Volunteers How does hospice work?

Hospice nurse and doctor are on-call 24 hours a day/7 days a week The hospice benefit allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility (such as uncontrolled pain, nausea, bleeding, etc.) How hospice works…continued

Important to note: Medicare covers benefits for any health problems that AREN’T RELATED to the terminal illness (like care from an injury – fall as an example) What is covered under the hospice benefit? Doctor services (visits for example) Nursing care (generally two x week or more if warranted) Medical equipment (wheelchairs, walkers, recliners, etc.) Medical supplies (wound care supplies, etc.) Medications (for symptom relief, pain control) Hospice aid services PT, OT, ST Social work services / dietary counseling Grief, loss, spiritual and bereavement counseling Short term respite care What Medicare covers:

Treatment intended to cure your terminal illness (as a hospice patient, you always have the right to stop hospice care at any time) Prescription drugs to cure your illness (rather than for symptom control or pain management) Care from any hospice provider that wasn’t set up by the hospice medical team Room and Board (Medicare does not cover room and board if you get hospice care in your home or live in a nursing home or a hospice inpatient facility; however, Medicare will cover room and board if the hospice team deems that short-term inpatient or respite services are needed Care in an emergency room, inpatient facility care, or ambulance transportation (unless it’s either arranged by your hospice team or is UNRELATED to terminal illness) Treatment intended to cure your terminal illness (as a hospice patient, you always have the right to stop hospice care at any time) Prescription drugs to cure your illness (rather than for symptom control or pain management) Care from any hospice provider that wasn’t set up by the hospice medical team Room and Board (Medicare does not cover room and board if you get hospice care in your home or live in a nursing home or a hospice inpatient facility; however, Medicare will cover room and board if the hospice team deems that short-term inpatient or respite services are needed Care in an emergency room, inpatient facility care, or ambulance transportation (unless it’s either arranged by your hospice team or is UNRELATED to terminal illness) What Medicare won’t cover:

What does the patient pay? Generally $5 co pay for each prescription drug and other similar products for pain relief and symptom control 5% of the Medicare-approved amount for inpatient respite For example: if Medicare pays $100 / day for inpatient respite care, the patient would be responsible for $5 / day (can change annually) Medicare pays the hospice provider

All Medicare-covered services provided while receiving hospice care are covered under Original Medicare, even if the patient has a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan Includes any Medicare-covered services for conditions UNRELATED to terminal illness provided by attending doctor. A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide Medicare Part A and Medicare Part B benefits; however if the plan covers extra services not covered by Original Medicare (like dental and vision benefits), the plan will continue to cover those extra services All Medicare-covered services provided while receiving hospice care are covered under Original Medicare, even if the patient has a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan Includes any Medicare-covered services for conditions UNRELATED to terminal illness provided by attending doctor. A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide Medicare Part A and Medicare Part B benefits; however if the plan covers extra services not covered by Original Medicare (like dental and vision benefits), the plan will continue to cover those extra services HMO / PPO or other Medicare health plan?

Continue to use Original Medicare to receive care for any health care needs that AREN’T related to your terminal illness Can receive care from the hospice team doctor or own doctor The hospice team determines whether any other medical care needed is or isn’t related to terminal illness so as not interfere with hospice benefit Medicare Supplemental Insurance (MEDIGAP) policies If patient has Original Medicare, Medigap covers hospice costs for medications and respite care along with covering any other health care costs for problems NOT related to terminal illness Continue to use Original Medicare to receive care for any health care needs that AREN’T related to your terminal illness Can receive care from the hospice team doctor or own doctor The hospice team determines whether any other medical care needed is or isn’t related to terminal illness so as not interfere with hospice benefit Medicare Supplemental Insurance (MEDIGAP) policies If patient has Original Medicare, Medigap covers hospice costs for medications and respite care along with covering any other health care costs for problems NOT related to terminal illness Receiving care for a condition OTHER than Terminal Illness

Intended for patients with 6 months or less to live if the disease process runs its normal course If patient lives greater than 6 months, patient can be recertified by hospice physician if deemed hospice appropriate (meets criteria as noted previously) Benefit periods: 2 – 90 day periods Followed by unlimited number of 60-day periods At the start of each period, the hospice physician must recertify that patient is terminally ill; A benefit period starts the day patient receives hospice care and ends when the 90- day or 60 day period ends Patient has the right to change hospice providers only ONCE during each benefit period Intended for patients with 6 months or less to live if the disease process runs its normal course If patient lives greater than 6 months, patient can be recertified by hospice physician if deemed hospice appropriate (meets criteria as noted previously) Benefit periods: 2 – 90 day periods Followed by unlimited number of 60-day periods At the start of each period, the hospice physician must recertify that patient is terminally ill; A benefit period starts the day patient receives hospice care and ends when the 90- day or 60 day period ends Patient has the right to change hospice providers only ONCE during each benefit period Receiving hospice services – how long?