End-of-Life Options for Medicare Patients Detailed
in New Regulation
Seniors choosing hospice or palliative care have
right to participate in treatment plan and more
June
5, 2008 - Medicare beneficiaries with terminal illnesses have their
right to determine how they receive end-of-life care outlined for the
first time in a new regulation to be published today by the Centers for
Medicare & Medicaid Services.
Specifically, the rule says, patients who choose
hospice, or palliative care, over curative treatment are entitled to
such things as participation in their treatment plan; the right to
effective pain management, the right to refuse treatment and the right
to choose his or her own physician.
In the first overhaul of regulations governing the
hospice industry since 1983, the new Medicare Conditions of
Participation (CoP), include explicit language on patient rights that
had not existed under the previous regulations.
Although many hospice patients are already active
in their own treatment plans, this regulation is the first to set out a
detailed list of patient rights.
“As more patients and their families come to
understand and select hospice care, we felt it was critical to outline
what rights patients have to control the care they receive in their
final days,” said Kerry Weems, acting administrator of CMS.
“End-of-life care has changed markedly in the past
25 years and it is time to update our regulations to reflect advances in
medicine and hospice industry practices as well as patient rights,”
Weems added.
Electing hospice care is a decision those with
terminal illnesses can make when they wish to forego further curative
treatment in favor of care designed to ease pain and other symptoms.
Hospice services provide comfort care to the patient and can include
services for family members. Hospice services can be provided in the
patient’s home or in an inpatient setting. Currently there are nearly
one million Medicare beneficiaries receiving care from over 3,000
Medicare-approved hospices nationwide.
The rule reflects comments received since the
publication of the proposed rule in May 2005. In addition to the new
patient rights’ section, final regulation also includes:
● A requirement that patient needs be initially
assessed within 48 hours of electing the hospice benefit. The rule also
requires that a comprehensive assessment occur within five days of
electing the hospice and that updated assessments be done at least every
15 days thereafter.
● A requirement that each patient receive a full
drug profile that examines issues ranging from the effectiveness of
current drug therapies to potential drug interactions to drug side
effects. A treatment team will consult with a qualified individual, such
as a pharmacist, to ensure that drugs meet the needs of every hospice
patient.
● A provision allowing a hospice to contract
with another Medicare-certified hospice for nursing, medical social
services, and counseling services under extraordinary or other
non-routine circumstances, including travel of a patient outside of the
hospice’s service area.
● Removal of a provision requiring an inpatient
facility only providing respite care to have an RN on duty 24 hours a
day. The patient’s needs, acuity and plan of care will drive the nursing
and staffing requirements.
June
5, 2008 - Medicare beneficiaries with terminal illnesses have their
right to determine how they receive end-of-life care outlined for the
first time in a new regulation to be published today by the Centers for
Medicare & Medicaid Services.