Date: 07/27/2009
Final
Overview of Medicaid and Hospice Care
HOSPICE AND PALLIATIVE CARE
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10:02 AM -- Overview of Medicaid and Hospice Care
Ms. Barbara Prehmus, Department of Health Care Policy and Financing, introduced herself and began her presentation regarding Medicaid and hospice care and distributed a copy of her presentation to the committee (Attachment C). She gave an overview of Colorado Medicaid benefits, noting that hospice care is an optional benefit which a state Medicaid program may choose to cover. She gave a number of statistics related to hospice care in the Medicaid program. Between July 2008 and June 2009, there were 3,168 unique hospice care clients. Expenditures for hospice over that period were $39.9 million. She discussed the cost of hospice care in various settings, including inpatient, nursing facility, and home-based settings. Ms. Prehmus discussed the number of clients served in various settings from July 2008 and June 2009. She discussed the payment of hospice care services for individuals who are eligible for both Medicare and Medicaid. In response to a question from Representative Roberts, she explained that the cost of care in a nursing facility is higher because Medicaid is also covering room and board costs.
10:11 AM
Ms. Prehmus discussed how individuals become eligible for Medicaid hospice care. A client must be Medicaid eligible, be categorically eligible for Medicaid, have a physician certification of life expectancy of six months or less, and elect palliative and supportive care rather than curative care. Ms. Prehmus discussed what is working well in the Medicaid hospice program, including the formation of a collaborative work group of stakeholders to solve issues relating to timely access to the hospice benefit, including for individuals who are not Medicaid eligible. Additionally, there have been some solutions to eligibility barriers, including enactment of legislation related to long-term care presumptive eligibility and revising rules to make persons entering hospice eligible for expedited assessments. Ms. Prehmus responded to questions from Representative Roberts regarding whether there it is possible to request permission from the federal government to extend the six-month expectancy period.
10:17 AM
Ms. Prehmus discussed what is not working in the Medicaid hospice benefit, including that reimbursement for room and board by Medicaid is limited to nursing facilities and that the federal hospice model does not match the "palliative care" model. She also discussed long-term care eligibility requirements and nursing facility requirements related to the minimum data set and the Preadmission Screening and Resident Review (PASRR). In response to a question from Senator Tochtrop, Ms. Prehmus responded that she does not know of any states that have obtained a waiver for these requirements. She discussed additional obstacles in hospice care beyond Medicaid, including that Colorado's average length of stay in hospice is shorter than the national average, and that advance directive forms are not readily available. Ms. Prehmus responded to committee questions about possible legislation to increase the use of hospice care, and possible issues with extending the six-month expectancy period to a year. She further responded to questions from Representative Roberts regarding the department's role in educating individuals about advance directive forms.
10:28 AM
Susan Langley, Patient Benefit Advisory, Denver Hospice, began her presentation regarding challenges and solutions in access and utilization for hospice patients with Medicaid and distributed a handout to the committee (Attachment D). She discussed a task force that is meeting to determine what is and isn't working with regard to patients with Medicaid. She stated that the process can be streamlined by looking at and improving current processes, and that presumptive eligibility in Medicaid is a step towards improvement. Ms. Langley discussed the PASRR. She discussed a recent survey of members of the Colorado Hospice and Palliative Care Organization regarding what changes in the present system would help with access and utilization of hospice services. The responses included:
- decreasing the length of time it takes to apply for services;
- accelerating the financial application process so that skilled nursing facilities will be more willing to accept patients who have applied for Medicaid;
- allowing the approval date for coverage for home hospice care to back date to the date of admission to a hospice program;
- clarifying the roles of home- and community-based services and hospice care providers;
- allowing providers to access information to allow better management of Medicaid services; and
- reviewing procedures regarding burial benefits for Medicaid patients.
Representative Roberts commented on the financial eligibility requirements for the Medicaid hospice benefit, and the potential for fraud.
10:49 AM
Ms. Langley discussed problems associated with adjustments in nursing facility room and board rates. She also discussed confusion that results when providers do not know what specific Medicaid program a person is enrolled in. Representative Roberts asked for clarification as to how rate adjustments in Medicaid and Medicare affect access to hospice care for patients. Ms. Langley responded to questions from Senator Newell regarding whether members of the hospice care task force described by Ms. Langley are in discussions with Congressional representatives regarding how federal health care reform could incorporate changes related to hospice care. Senator Williams discussed the Medicaid application process and how to streamline the process.
11:01 AM
Ms. Langley commented on recent legislation regarding advanced practice nurses. She stated that Medicaid cannot be billed if hospice patients are treated by advanced practice nurses. She also discussed the hospice benefit offered in private health insurance policies and the Colorado Indigent Care Program (CICP). The committee recessed briefly.