Hospice care is covered under Medicare Part A (Hospital Insurance). You are eligible for Medicare hospice benefits when you meet the following conditions:
•You are eligible for Medicare Part A
•Your doctor and the hospice medical director certify that you are terminally ill with a prognosis of six months or less if the disease runs its normal course.
•You sign an election of benefits form choosing hospice care, and covered benefits •Medicare will still pay for covered benefits for any health problems that are not related to your terminal illness.
Hospice care is covered under Medicare, Medicaid, Ameri Group/Amerivantage, Care Improvement Plus, Molina, Tricare For Life, Veteran Affairs, Blue Cross Blue Shield (HMO, PPO, Essentials, and Blue Advantage), Superior, United and other managed care organizations.
The patient provides informed consent to be admitted to hospice.
General guidelines for admission for hospice services include:
•A person with a serious illness whose prognosis may be six months or less, if the disease runs its normal course as determined by the medical judgment of the person’s primary physician
•A person who, along with his/her physician, desires palliative care intended to relieve suffering and the symptoms accompanying the disease process
•A primary physician consents to hospice care for him/her. If the patient has no attending physician the medical director may serve as the physician.
•Patient and/or family agree not to treat terminal illness
Criteria for Admission and Guidelines for Determining Prognosis
Generations Hospice care determines appropriateness for hospice care for cancer and non-cancer diagnosis by using Medicare guidelines. Non-cancer diagnosis include End Stage Dementia, End Stage Renal Disease, End Stage Cardiac Disease, End Stage Pulmonary Disease, End Stage Liver Disease, HIV Disease, Stroke and Coma, Failure to thrive and Amyotrophic Lateral Sclerosis.
In addition to meeting other disease specific criteria, Hospice patients may also exhibit the following in the past 3 to 6 months:
•Decline/Decrease in Activities of Daily Living (ADL)
•Weight loss or decreased appetite
•Decline/decrease in cognitive abilities
•Observable changes in physical condition
•Lack of response to treatment and worsening of symptoms of a chronic underlying disease