NHPCO NewsLine Fall 2019 - 16

continued

timely access to this information
in order to promote continuity of
care and communication
amongst all patient providers and
to ensure appropriate claims
submission."

Will CMS provide additional
guidance on unrelatedness?
A: We [CMS] remind commenters
that since the implementation of
the Medicare hospice benefit, it
has been our position that
virtually all of the care needed by
terminally ill individuals should be
provided by the hospice (48 FR
56010). As such, there should not
be a voluminous list of unrelated
items, services, and drugs given
the comprehensive nature of
hospice services under the
Medicare hospice benefit and the
requirement that the hospice
provide care addressing the
physical, medical, psychosocial,
emotional, and spiritual needs of
hospice patients and families
facing terminal illness and
bereavement.

Should we use the
addendum to communicate
with non-hospice providers
or suppliers?
A: CMS reminds providers that
"the ongoing sharing of
information with other nonhospice healthcare providers and
suppliers furnishing services
unrelated to the terminal illness
and related conditions is
necessary to ensure coordination
of services and to meet the
patient, family, and caregiver

16

Newsline / Fall 2019

needs. [§ 418.56(e)(5)] The
coordination requirements include
that the hospice must develop
and maintain a system of
communication and integration
amongst all providers furnishing
care to the terminally ill patient.
For non-hospice providers or
suppliers billing Medicare for
services received by hospice
beneficiaries unrelated to their
terminal illness and related
conditions, this includes being
able to provide documentation
from the hospice listing the
conditions (and thus items, drugs,
and services) the hospice
determined to be unrelated and
documented as such on the
hospice plan of care."

How does the new
addendum requirement
interface with Part D?
A: We [CMS] intend to work with
hospices and Part D plans to
develop a process in which the
addendum potentially could be
used at the point-of-service when
hospice beneficiaries are filling
drug prescriptions to ensure
timely access to needed drugs.
Complete documentation on the
part of the hospice, coupled with
timely notification of Part D
sponsors, mitigates the risk for
possible double payment by the
Medicare program for drugs, and
is anticipated to prevent Part D
enrollees in hospice from having a
hospice related medication billed
by a pharmacy to their Part D
plan, potentially subjecting the
beneficiary to out-of-pocket
expenses.

Why is the addendum a
Condition of Payment?
A: While we understand
stakeholder concerns about
including an addendum
statement as a condition for
payment, we believe this is
necessary to ensure that hospices
are diligent in providing this
information to Medicare hospice
beneficiaries on request. We
regard this addendum as an
important mechanism of
accountability for hospices to
provide coverage information to
beneficiaries electing the hospice
benefit. We also believe that the
various reports by the OIG (for
example; OEI-02-16-00570, July,
2018, "Vulnerabilities in the
Medicare Hospice Program Affect
Quality Care and Program
Integrity: An OIG Portfolio," 37
and A-06-10-00059, June 2012,
"Medicare Could Be Paying Twice
For Prescription Drugs For
Beneficiaries In Hospice")
highlight the issues with a
patient's lack of knowledge of
hospices' limitation on their
coverage, and the possibility of
hospices potentially not covering
items, services, and drugs that
should be hospices' responsibility.
We reiterate that the election
statement addendum, as a
condition for payment, would
achieve the goal of increasing
comprehensive patient education,
awareness, empowerment, and
coverage transparency. We [CMS]
continue to believe that as a
condition for payment, this would
ensure a more comprehensive and
thoughtful approach by hospices
NHPCO NewsLine Fall 2019

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