Benefit

The Hospice Benefit, as defined by Medicare/Medi-Cal, is designed to support the needs of the patient and his/her family. Hospice Benefits for Medicare/Medi-Cal patients are available for anyone no longer pursuing aggressive treatment.

The Hospice Benefit is comprehensive; it provides for services of the Hospice interdisciplinary team (including physicians, nurses, home health aides, social workers, pastoral care and bereavement counselors, and volunteers), all ancillary services (physical therapy, respiratory therapy, occupational therapy, nutritional counseling), all durable medical equipment and supplies, and all pharmaceuticals and biologicals.

The chart below offers a comparison of Medicare/Medi-Cal Hospice Benefits with the benefits offered by hospital and home health agencies.

SERVICE ITEM	HOSPICE	HOSPITAL	HOME HEALTH
Medications to be used as approved by hospice for control of pain and other symptoms	YES	NO	NO
Durable Medical Equipment as approved by hospice (e.g., bed, commode, table, wheelchair, oxygen)	100%	100%	80%
Coverage even if patient is not homebound	YES	N/A	LIMITED
Deductible waived	YES	NO	NO
Inpatient respite care to provide rest for patient caregivers	YES	N/A	NO
Continuous care at home during periods of crisis	YES	N/A	NO
Counseling services at home for both the patient and the family	YES	NO	LIMITED
Homemakers	YES	NO	NO
Bereavement counseling/Pastoral Care	YES	NO	NO
Availability of trained volunteers	YES	NO	NO
Availability of inpatient care as back up to home care	YES	NO	NO
Care must continue after benefits end	YES	NO	NO

What is the medicare hospice benefit?

Hospice is a specialized form of multidisciplinary care, which is designed to provide palliative care (alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal illness) and to provide supportive care to the primary caregivers and the family of the hospice patient.

Who is eligible?

• Any individual who is eligible for Medicare Part A benefits.
• Any individual who is eligible for Medi-Cal benefits.
• Any individual who is eligible for full scope hospice benefits under private insurance.
• Diagnosed terminally ill with a prognosis of six months or less, with physician approval for hospice care.
• Diagnosis certified by both the attending physician and the hospice medical director.
• Patient, family, or significant other elect hospice care and agree to no aggressive treatment.

How is coverage implemented and for what period of time?

• Coverage is for a total of 210 days (two 90-day periods and unlimited 60-day periods).
• Medi-Cal has 2-90 day periods and 1-30 day period with no 4th benefit.
• Each benefit period stands alone and must be certified by the physician each time.

What is covered under the hospice benefit?

• Nursing services for a patient with routine care - average 1-2 visits per week - 24 hour availability - 7 days a week.
• Social Services.
• Physician services - patient’s personal attending physician and Hospice Medical Director.
• Home Health Aide - average 2-3 visits per week.
• Trained volunteers.
• Medications, DME, and medical supplies (related to the terminal illness).
• Chaplain (non-denominational spiritual support).
• Bereavement counseling.
• Therapist, as needed and approved by hospice.
• Note: Frequency of hospice services are based on the identified needs of the patient, family/significant other.