New CMS Guidance Issued on Part D and Hospice

Since March, the National Hospice and Palliative Care Organization has been working with the hospice community and many Congressional champions to halt implementation of a Medicare Part D policy that resulted in dying patients unable to get necessary medications under their Part D benefit. These efforts have been successful.

Today, the Centers for Medicare and Medicaid Services issued revised, interim guidance for hospice providers and Part D sponsors pertaining to Medicare beneficiaries who are receiving hospice care and are also enrolled in Part D.  The intention of the Medicare Part D policy is to prevent the federal government from paying for medications under Part D that are related to the terminal illness and should be the responsibility of the hospice.

This new Part D guidance substantially modifies guidance first issued on March 10, 2014 which generated confusion and concern for hospice providers and Part D sponsors, and most importantly, prevented hospice patients from accessing needed drugs.

An NHPCO survey of hospice professionals found the policy often left Medicare beneficiaries without needed medications unrelated to the terminal illness once they had elected their Medicare hospice benefit. Other dying patients either revoked or refused the hospice benefit, foregoing this compassionate care, in order to maintain access to medications unrelated to their terminal prognosis.
Since the March implementation, dying hospice patients and their family caregivers found themselves caught in the middle of the policy which many in the hospice community called well-intentioned yet misguided.

The revised guidance instructs Part D sponsors to use prior authorization only on four categories of drugs that are generally used to treat symptoms of pain, nausea, constipation and anxiety commonly seen in hospice patients. Prior authorization requirements on other categories of drugs will no longer be required from Part D sponsors.

The modified guidance was issued after months of intense discussion with CMS, Congress, and other stakeholders on the problems with the March guidance and a request from NHPCO to temporarily suspend the guidance until the issues could be resolved.
  
“We are pleased that CMS has taken this step to revise the March 10 guidance in keeping with the 2012 OIG report.  It will reduce the confusion for hospice providers and will allow patients to get their medications when they need them,” said J. Donald Schumacher, NHPCO president and CEO.
“As frontline caregivers, the hospice community led the effort to educate Congress and engage with stakeholders to halt the policy.  With this change, patients and their families will no longer be caught in the middle of troublesome policy and stakeholders can implement an interim solution that can more easily be understood by all providers,” Schumacher added.

NHPCO does not dispute hospices’ responsibility in paying for all medications and care related to patient’s terminal prognosis and will continue working to educate the hospice community on better navigating this intersection. 
CMS and all stakeholders will continue working to identify a more permanent solution to this Part D and hospice intersection.  Added Schumacher, “We remain committed to working collaboratively with all stakeholders to ensure that hospice patients receive the medications they need for comfort and quality of life and do not have to experience confusion and delay as they are facing the end of life.”

Focused Advocacy and Congressional Sign-on Letters Further Highlight Part D Issue

July marks the entry into the third month of implementation of the damaging policy involving Medicare Part D and hospice patient medications.  In response, the National Hospice and Palliative Care Organization reports a surge in advocacy activity to halt the negative consequences on dying Medicare beneficiaries

The poorly conceived policy issued by the Centers for Medicare and Medicaid Services, with a May 1, 2014 implementation date, was designed to prevent duplicate payments on medications for hospice patients. The unintended result of this policy is causing many dying Americans to forgo necessary medications that should be covered under Medicare Part D.

Through the efforts of Hospice Advocates across the nation, both Congress and CMS have heard what this misguided policy is doing to the patients and families being cared for by hospice providers.

“Coordinated advocacy efforts have brought some positive results but not a halt to the implementation of this policy,” said J. Donald Schumacher, NHPCO president and CEO. “Yet, even one patient at the end of life who suffers needlessly from this policy is one too many. It’s heartbreaking that CMS has failed to recognize the urgency of protecting these vulnerable patients.”

Congressional sign-on letters circulated by Senators Rockefeller and Roberts (PDF) and Representatives Reed and Thompson (PDF) emphasized the call for CMS to act.

The letters were signed by 75 Senators and 202 Members of the House of Representatives. Nineteen out of 24 Members of the Senate Finance Committee, which has jurisdiction over hospice in the Senate, and 26 out of 39 Members of the House Ways & Means Committee, which has jurisdiction over hospice in the House of Representatives, signed on to these letters.

Additional measures calling on CMS to stop implementation of the Part D policy include:

• Letter by Senate Majority Leader Harry Reid (PDF).
• Coalition letter from over 45 stakeholder groups (PDF).
• CMS hosted stakeholder meeting, where all stakeholder groups (Part D Plans, Hospices, Pharmacy Providers, Patient Groups, and NHPCO) unanimously called for a halt to implementation.

Additionally, last week, even the Medicare Payment Advisory Commission (MedPAC) commented on the guidance, and suggested that the guidance be suspended until a streamlined process, that does not impact the Medicare beneficiary, can be implemented.

For more information on this issue, please visit the Hospice Action Network’s Hospice & Part D webpage at hospiceactionnetwork.org/partD.

Call to Action: Contact your legislators to support hospice care!

Today, you can make a tangible difference for hospices across the nation. Hospice Action Network and the National Hospice and Palliative Care Organization are encouraging all hospice supporters to call their Members of Congress and voice their concern about the Hospice & Medicare Part D issue.

On June 17, over 240 of your fellow Hospice Advocates, representing 47 states and districts, and every discipline in the IDT, are in Washington, DC, visiting more than 300 Congressional offices to call for support of hospice.

Advocates on Capitol Hill will request that Congress ask CMS to temporarily suspend the Part D implementation for hospices- and Americans across the national are needed to convey this same message from their homes.  

The Hospice Action Network has created an easy to use online "Click to Call" Campaign that will help people understand the issue and then connect them to their Congressional representatives. The whole process should take no longer than 30 minutes, start to finish- that’s all it takes for you to make a difference.

To watch our video, which explains the Part D policy changes, and how the calling system works to connect you to your Members of Congress, visit this special page of the Hospice Action Network website.

 

CMS Part D policy hurting hospice patients and families

A hospice patient in Oklahoma City is being denied his medications to treat his COPD, while coping with a diagnosis and treatment for tongue cancer.  In Cadillac, Michigan a patient struggling with colon cancer is being denied insulin to treat his diabetes and is in danger of diabetic shock.

Due to a recent and poorly thought out Medicare Part D Prescription Drug policy, dying patients are revoking hospice services to maintain access to other necessary prescriptions for diseases unrelated to their terminal illness that Part D have paid for until recently. 

Patients’ families are left at the pharmacy counter with no refill of medications, after the pharmacist announces that because the patient is on hospice, the pharmacy is no longer allowed to fill their prescriptions – which in not accurate.  Or they are going days, sometimes weeks, without the necessary medication to manage symptoms that were present before they elected the hospice benefit due to unnecessary complications in approving prescriptions under Part D.

The intention of the new Medicare Part D policy implemented by the Centers for Medicare and Medicaid Services is to prevent the federal government from incurring duplicate costs for medications of hospice patients. 

The National Hospice and Palliative Care Organization has strongly opposed the inadequate and haphazard implementation of this guidance. 

NHPCO agrees that hospice providers should be held responsible for all drugs that are related to the terminal diagnoses and those drugs that are unrelated should be billed to Medicare Part D.  

NHPCO acknowledges that there have been instances of Part D payment for drugs that should have been covered by the hospice provider under the Medicare hospice benefit. 

NHPCO continues to encourage CMS to halt the implementation of the Part D guidance and convene key stakeholder groups to collaborate and create a strategic and uniform process.  An effective solution can be reached so that Part D providers, pharmacists, hospice providers and beneficiaries have developed a coherent process together and hospice patients are not denied the medications they need at the end of life.    

NHPCO and NHF Mourn the Death of Chair Emeritus Zachary Morfogen

With much sadness the National Hospice and Palliative Care Organization and the National Hospice Foundation share the news of the death of Zachary Paul Morfogen, of Palm Beach who died Tuesday, May 27, 2014. He was 85 and was with family in Pennsylvania at the time of his death.

As founding chairman emeritus of what was the National Hospice Organization and the National Hospice Foundation, Mr. Morfogen was a longtime advocate for hospice and currently served on the Foundation’s Board of Governors.

He became one of the nation’s earliest advocates for hospice care during his tenure as a trustee of Riverside Hospital in New Jersey.  While there, Mr. Morfogen persuaded Riverside Hospital to establish one of the nation’s first free-standing hospices and later convinced Time magazine to do a story about the then growing hospice movement in the U.S.

During the early years of his work with Riverside Hospital, Mr. Morfogen saw firsthand the need for more compassionate care for the dying. At the suggestion of a colleague, he visited Cicely Saunders, founder of St. Christopher’s Hospice in London and widely recognized as the founder of the modern day hospice model. About his visit at St. Christopher’s he shared:

One day there, I saw a hospice patient who had to be in her eighties celebrating her birthday – big party, cake, candles, the whole bit. I said to Cicely, “So, how long does she have left?” Cicely said, “Oh, about a week.” I thought, wow, what a difference between what this was and what I saw at Riverside.

He was dedicated to the arts and was actively involved in the creation of the ground-breaking exhibition, “Hospice: A Photographic Inquiry,” that opened at the Corcoran Gallery of Art in Washington, DC in 1996 and then toured the nation.

A love for the power of art to communicate and educate led to the creation of the National Hospice Foundation’s Zachary Morfogen Art of Caring Award which recognizes those who use the arts to increase awareness of hospice care.

Mr. Morfogen was a painter and author whose books included You Gotta’ Have Art and Dealing with Death Free From Fear which was published only this month.

He is survived by his two children and their spouses, seven grandchildren, two great-grandchildren, and a sister. His beloved wife, Marilyn, died in 2011.

Memorial contributions may be made in his memory to the National Hospice Foundation, 1731 King St., Alexandria, VA 22314 or The Roosevelt Institute, New York, NY.

Mr. Morfogen’s obituary and online condolence book are available online.

Ground-breaking Palliative Care Resolution Adopted at World Health Assembly in Geneva

Signals progress to end unnecessary pain and suffering due to lack of quality care

The National Hospice and Palliative Care Organization joins other palliative care advocates across the globe in celebrating the resolution on palliative care adopted at the World Health Assembly on May 23, 2014 in Geneva, Switzerland.

The adoption of this first-ever resolution calling for the integration of hospice and palliative care  into national health services reflects growing awareness of the unaddressed care needs for the millions of people worldwide with  life-limiting conditions such as cancer, heart disease, HIV, and multi-drug resistant TB.

The resolution outlines clear recommendations to improve access and availability of hospice and palliative care. These include ensuring palliative care is included in all national health policies and budgets, and in the curricula for health professionals.  Iit also highlights the critical need for countries to ensure that there is an adequate supply of all essential palliative care medicines for appropriate pain control for adults and children.

The Sixty-seventh session of the World Health Assembly  took place in Geneva May, 19 – 24, 2014. The WHA is the supreme decision-making body of World Health Organization.

Read the full NHPCO press release (05/28/14).

NHPCO Launches New Moments of Life Campaign

Patients’ and families’ stories show hospice is about more than death – it’s about life

In celebrating the 40^th anniversary of hospice care in the United States, NHPCO is excited to introduce a new national campaign, “Moments of Life: Made Possible by Hospice,” that will show all Americans that hospice focuses on living and enables special moments and memories at the end of a life for patients and loved ones.

A father’s final wedding dance with his daughter; a Veteran’s visit to the WWII Memorial; the opportunity to bring an infant daughter home; an afternoon tea party with grandchildren… these are only some of the moments made possible by hospice.

The Moments of Life awareness campaign will feature stories gathered by hospices across the country of patients and families experiencing hospice care first hand. The stories will take the form of videos, photos, audio recordings and text and will offer a vibrant cross-section of different perspectives of hospice.

“In this campaign, we are looking for real stories that show patients’ abilities to ‘do more’ as a result of their experience on hospice,” said Anita Brikman, senior vice president of communications for NHPCO. “No matter what format is used, these stories should show America that even when you’re dying, there is still a lot of living to do.”

For many who have not seen hospice in action, it has become a common misconception that hospice patients are merely lying in bed, waiting for their end to come. For families who have experienced hospice, they see the focus is not on dying—it is about living as fully as possible.  Hospice not only provides the highest quality care, it affords more moments, memories and opportunities.  

For more information visit the new Moments of Life microsite at MomentsOfLife.org.