New CMS Hospice Modification to Improve Expectations for Medications and Services

CMS’ modifications to the content of the election statement and added a new addendum requirement to increase coverage transparency for patients under a hospice election within the Hospice 2020 Final Payment Rule & Quality Update went into effect October 1, 2020.

This modification applies to medication appropriateness as hospices now must provide Medicare beneficiaries with a written statement called a “Patient Notification of Hospice Non-Covered Items, Services, and Drugs” detailing the conditions, items, services or drugs that are determined to be unrelated to their terminal illness and conditions and not covered by the hospice benefit.

Hospices must issue the written addendum within 72 hours of a request made by the beneficiary, their representative, a non-hospice provider or a medical contractor. This modification is intended to reduce or eliminate confusion related to expected medications or services provided.

Hospice drugs are paid under Medicare Part A. Drugs unrelated to the treatment of the terminal illness must be billed to Medicare Part D. For prescriptions covered under Part A, the pharmacy negotiates a fair and reasonable fee since the hospice provider is paid a capitated rate for services provided. 

Pharmacists can improve the cost-effectiveness of pharmacotherapy for symptom control in hospice care through patient-specific monitoring for drug therapy outcomes, recommending alternative drug products and dosage forms, minimizing duplicative and interacting medications, compounding medications extemporaneously, improving drug storage and transportation, and educating staff, patients, and families about the most efficient ways of handling, destroying, and using medications.

Takeaway: Pharmacists may now have a better opportunity to improve hospice patient care by being more involved in the care process