REPORT TITLE:
Hospice Care Reimbursement


DESCRIPTION:
Beginning 1/1/2000, requires all health insurers and HMOs to
reimburse to hospice care providers a minimum rate set by the
Health Care Financing Administration per day for hospice care and
an additional $____ per day for room and board expenses of
hospice care providers in excess of the Health Care Financing
Administration rate.  Makes a hospice referral visit a
reimbursable benefit regardless of whether or not a patient is
admitted to hospice care.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           847
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT
RELATING TO HOSPICE CARE REIMBURSEMENT.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  The blue ribbon panel on living and dying with
 
 2 dignity was formed by the governor in late 1996 to consider the
 
 3 many issues involved in death and dying and to suggest guidelines
 
 4 for public policy.  In May, 1998, the blue ribbon panel issued
 
 5 its final report and made seven recommendations, six of which
 
 6 were made unanimously.  The fourth unanimous recommendation
 
 7 recommends that hospice care be made more available and offered
 
 8 more expediently to the dying.
 
 9      Hospice care is not a place.  It is a service that can be
 
10 delivered at home, in a freestanding unit operated by the
 
11 hospice, in nursing or care homes, or even in beds set aside in
 
12 acute care hospitals.  Hospice care is a philosophy which accepts
 
13 that an illness has progressed to a terminal stage, and death
 
14 cannot be avoided even with aggressive medical treatment.  The
 
15 goal of hospice care is not to prolong life, but to make dying as
 
16 comfortable as possible for the person dying, and for family and
 
17 friends.  The blue ribbon panel asserts that if pain management
 
18 can be improved and hospice care increased, many of Hawaii's
 
19 health care providers believe that few people would consider
 

 
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                                     S.B. NO.           847
                                                        
                                                        

 
 1 physician-assisted death, which may be viewed as desirable when
 
 2 pain is not controlled and when the patient foresees being in a
 
 3 sterile or strange hospital or other residential program, rather
 
 4 than dying at home in the presence of loved ones.
 
 5      The legislature finds that hospice care not only increases
 
 6 patient satisfaction but also almost always costs less than
 
 7 either hospital care or other forms of acute care at the end of
 
 8 life.  Yet, hospice care is underutilized.  Each year, of eight
 
 9 thousand deaths in Hawaii, five thousand could have benefitted
 
10 from hospice care, yet only about one thousand five hundred
 
11 persons received hospice care.
 
12      According to the blue ribbon panel, the Medicare per diem
 
13 rate of $107 would establish a floor but this rate would still
 
14 not allow hospice providers to recover their full costs amounting
 
15 to $160 to $210 per day in room and board costs.  If this
 
16 additional cost were reimbursed, it would still be lower than the
 
17 $458 per diem Medicaid reimbursement for similar costs in acute
 
18 care hospitals.
 
19      The blue ribbon panel also specifically recommended making
 
20 hospice referral visits a reimbursable benefit regardless of
 
21 whether a patient is eventually admitted to a hospice or not.
 
22 Implementing this recommendation would go a long way towards
 

 
 
 
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                                     S.B. NO.           847
                                                        
                                                        

 
 1 encouraging greater use of hospice care on a timely basis.
 
 2      The purpose of this Act is to implement two specific
 
 3 recommendations made by the blue ribbon panel regarding hospice
 
 4 care:
 
 5      (1)  To make the Medicare per diem rate, the current rate
 
 6           set by the Health Care Financing Administration, the
 
 7           base rate for hospice care and to additionally
 
 8           reimburse room and board expenses of hospice
 
 9           facilities; and
 
10      (2)  To make hospice referral visits a reimbursable benefit
 
11           at the rate under paragraph (1) regardless of whether a
 
12           patient is eventually admitted to a hospice or not.
 
13      SECTION 2.  Chapter 431, Hawaii Revised Statutes, is amended
 
14 by adding a new section to article 10A to be appropriately
 
15 designated and to read as follows:
 
16      "§431:10A-     Hospice care; minimum reimbursement for
 
17 hospice care; minimum and maximum reimbursement for room and
 
18 board expenses of hospice care providers; referral visits;
 
19 notice.  (a)  Any other law to the contrary notwithstanding,
 
20 commencing on January 1, 2000, all authorized insurers issuing or
 
21 renewing an employer group health policy, contract, plan, or
 
22 agreement in this State that provides for payment of or
 

 
 
 
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                                     S.B. NO.           847
                                                        
                                                        

 
 1 reimbursement for hospice care, shall reimburse hospice care
 
 2 providers for each insured policyholder covered for hospice care
 
 3 according to the following schedule:
 
 4      (1)  A minimum daily rate as set by the Health Care
 
 5           Financing Administration for hospice care; and
 
 6      (2)  An amount of $     per day for room and board expenses
 
 7           directly related to the hospice care being provided in
 
 8           excess of the rate in paragraph (1).
 
 9 In addition, each hospice referral visit during which a patient
 
10 is advised of hospice care options shall be considered a
 
11 reimbursable benefit regardless of whether the referred patient
 
12 is eventually admitted to hospice care.
 
13      (b)  Every insurer shall provide notice to its policyholders
 
14 regarding the coverage required by this section.  The notice
 
15 shall be in writing and prominently positioned in any literature
 
16 or correspondence sent to policyholders and shall be transmitted
 
17 to policyholders within calendar year 1999 when annual
 
18 information is made available to policyholders, or in any other
 
19 mailing to policyholders, but in no case later than December 31,
 
20 1999."
 
21      SECTION 3.  Chapter 432, Hawaii Revised Statutes, is amended
 
22 by adding a new section to be appropriately designated and to
 

 
 
 
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                                     S.B. NO.           847
                                                        
                                                        

 
 1 read as follows:
 
 2      "§432-     Hospice care; minimum reimbursement for hospice
 
 3 care; minimum and maximum reimbursement for room and board
 
 4 expenses of hospice care providers; referral visits; notice.  (a)
 
 5 Any other law to the contrary notwithstanding, commencing on
 
 6 January 1, 2000, all authorized insurers issuing or renewing an
 
 7 individual and group hospital or medical service plan, policy,
 
 8 contract, or agreement in this State that provides for payment of
 
 9 or reimbursement for hospice care, shall reimburse hospice care
 
10 providers for each insured member covered for hospice care
 
11 according to the following schedule:
 
12      (1)  A minimum daily rate as set by the Health Care
 
13           Financing Administration for hospice care; and
 
14      (2)  An amount of $     per day for room and board expenses
 
15           directly related to the hospice care being provided in
 
16           excess of the rate in paragraph (1).
 
17 In addition, each hospice referral visit during which a patient
 
18 is advised of hospice care options shall be considered a
 
19 reimbursable benefit regardless of whether the referred patient
 
20 is eventually admitted to hospice care.
 
21      (b)  Every insurer shall provide notice to its members
 
22 regarding the coverage required by this section.  The notice
 

 
 
 
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                                     S.B. NO.           847
                                                        
                                                        

 
 1 shall be in writing and prominently positioned in any literature
 
 2 or correspondence sent to members and shall be transmitted to
 
 3 members within calendar year 1999 when annual information is made
 
 4 available to members, or in any other mailing to members, but in
 
 5 no case later than December 31, 1999."
 
 6      SECTION 4.  Chapter 432D, Hawaii Revised Statutes, is
 
 7 amended by adding a new section to be appropriately designated
 
 8 and to read as follows:
 
 9      "§432D-     Hospice care; minimum reimbursement for hospice
 
10 care; minimum and maximum reimbursement for room and board
 
11 expenses of hospice care providers; referral visits; notice.  (a)
 
12 Any other law to the contrary notwithstanding, commencing on
 
13 January 1, 2000, each health maintenance organization that
 
14 provides health coverage to its enrollees in this State and that
 
15 provides for payment of or reimbursement for hospice care, shall
 
16 reimburse hospice care providers for each insured enrollee
 
17 covered for hospice care according to the following schedule:
 
18      (1)  A minimum of $107 per day for hospice care; and
 
19      (2)  A minimum of $160 and a maximum of $210 per day for
 
20           room and board expenses directly related to the hospice
 
21           care being provided in excess of the rate in paragraph
 
22           (1).
 

 
 
 
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                                     S.B. NO.           847
                                                        
                                                        

 
 1 In addition, each hospice referral visit during which a patient
 
 2 is advised of hospice care options shall be considered a
 
 3 reimbursable benefit regardless of whether the referred patient
 
 4 is eventually admitted to hospice care.
 
 5      (b)  Every insurer shall provide notice to its enrollees
 
 6 regarding the coverage required by this section.  The notice
 
 7 shall be in writing and prominently positioned in any literature
 
 8 or correspondence sent to enrollees and shall be transmitted to
 
 9 enrollees within calendar year 1999 when annual information is
 
10 made available to enrollees, or in any other mailing to
 
11 enrollees, but in no case later than December 31, 1999."
 
12      SECTION 5.  New statutory material is underscored.
 
13      SECTION 6.  This Act shall take effect upon its approval.
 
14 
 
15                              INTRODUCED BY:______________________