REPORT TITLE:
Hospice Care Reimbursement


DESCRIPTION:
Requires health insurers to cover hospice care; requires the
Department of Health to adopt rules for patient self-
determination; allows hospice homes in areas zoned residential.
(SD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        851
THE SENATE                              S.B. NO.           S.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT
RELATING TO HEALTH CARE.


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 found that many of Hawaii's
 
18 health care providers believe that if pain management can be
 
19 improved and hospice care increased, few people would consider
 
20 physician-assisted death, which may be viewed as desirable when
 

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

 
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 1 care:
 
 2      (1)  To make the Medicare per diem rate, the current rate
 
 3           set by the Health Care Financing Administration, the
 
 4           base rate for hospice care and to additionally
 
 5           reimburse room and board expenses of hospice
 
 6           facilities; and
 
 7      (2)  To make hospice referral visits a reimbursable benefit
 
 8           at the rate under paragraph (1) regardless of whether a
 
 9           patient is eventually admitted to a hospice or not.
 
10      SECTION 2.  Chapter 46, Hawaii Revised Statutes, is amended
 
11 by adding a new section to be appropriately designated and to
 
12 read as follows:
 
13      "§46-    Hospice homes; permitted use in residential areas.
 
14 For purposes of section 46-4, a hospice home shall be considered
 
15 a residential use of property and shall be a permitted use in
 
16 residentially designated zones, including but not limited to,
 
17 zones for single-family dwellings.  No conditional use, permit,
 
18 variance, or special exception shall be required for a residence
 
19 used as a hospice home.
 
20      For purposes of this section, "hospice home" means any
 
21 facility operated by a licensed hospice service agency providing
 
22 twenty-four hour living accommodations to no more than five
 
23 unrelated persons who are admitted to the hospice program of
 
24 care."
 

 
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 1      SECTION 3.  Chapter 321, Hawaii Revised Statutes, is amended
 
 2 by adding a new section to be appropriately designated and to
 
 3 read as follows:
 
 4      "§321-    Patient self-determination.  The department of
 
 5 health shall adopt rules pursuant to chapter 91 relating to:
 
 6      (1)  Patient self-determination during end of life medical
 
 7           care, including compliance with a patient's advance
 
 8           directives if a patient is transferred between medical
 
 9           facilities.  For the purposes of this chapter, "advance
 
10           directive" means any expression of intent by a patient
 
11           with respect to end of life medical care that complies
 
12           with state law or the Patient Self-Determination Act
 
13           (42 U.S.C. 1395, et seq); and
 
14      (2)  Pain management during end of life care, including:
 
15           (A)  Establishing industry standards for the treatment
 
16                of pain based on the guidelines issued by the
 
17                Agency for Healthcare Policy and Research of the
 
18                United States Department of Health and Human
 
19                Services at all applicable department certified or
 
20                licensed facilities;
 
21           (B)  Establishing a right to skilled pain management,
 
22                requiring a pain management program, and including
 
23                pain management in continuing education training
 
24                at such facilities; and
 

 
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                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           (C)  Licensing and certification teams, including pain
 
 2                management criteria in the care of patients.
 
 3      SECTION 4.  Chapter 431, Hawaii Revised Statutes, is amended
 
 4 by adding a new section to article 10A to be appropriately
 
 5 designated and to read as follows:
 
 6      "§431:10A-     Hospice care coverage.  (a)  Any other law to
 
 7 the contrary notwithstanding, commencing on January 1, 2000, all
 
 8 authorized insurers that provide for payment of or reimbursement
 
 9 for hospice care, shall reimburse hospice care providers for each
 
10 insured policyholder covered for hospice care according to the
 
11 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 policyholders
 
22 regarding the coverage required by this section.  The notice
 
23 shall be in writing and prominently positioned in any literature
 

 
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                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 or correspondence sent to policyholders and shall be transmitted
 
 2 to policyholders annually, beginning with calendar year 1999
 
 3 along with any other mailing to policyholders, but in no case
 
 4 later than December 31, 1999."
 
 5      SECTION 5.  Chapter 432:1, Hawaii Revised Statutes, is
 
 6 amended by adding a new section to be appropriately designated
 
 7 and to read as follows:
 
 8      "§432:1-   Hospice care coverage.  (a)  Any other law to the
 
 9 contrary notwithstanding, commencing on January 1, 2000, all
 
10 mutual benefit societies issuing or renewing an individual and
 
11 group hospital or medical service plan, policy, contract, or
 
12 agreement in this State that provides for payment of or
 
13 reimbursement for hospice care, shall reimburse hospice care
 
14 providers for each insured member covered for hospice care
 
15 according to the following schedule:
 
16      (1)  A minimum daily rate as set by the Health Care
 
17           Financing Administration for hospice care; and
 
18      (2)  An amount of $     per day for room and board expenses
 
19           directly related to the hospice care being provided in
 
20           excess of the rate in paragraph (1).
 
21 In addition, each hospice referral visit during which a patient
 
22 is advised of hospice care options shall be considered a
 
23 reimbursable benefit regardless of whether the referred patient
 
24 is eventually admitted to hospice care.
 

 
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                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1      (b)  Every insurer shall provide notice to its members
 
 2 regarding the coverage required by this section.  The notice
 
 3 shall be in writing and prominently positioned in any literature
 
 4 or correspondence sent to members and shall be transmitted to
 
 5 members annually, beginning with calendar year 1999 along with
 
 6 any other mailing to members, but in no case later than December
 
 7 31, 1999."
 
 8      SECTION 6.  Section 432D-23, Hawaii Revised Statutes, is
 
 9 amended to read as follows:
 
10      "[[]§432D-23[]]  Required provisions and benefits.
 
11 Notwithstanding any provision of law to the contrary, each
 
12 policy, contract, plan, or agreement issued in the State after
 
13 January 1, 1995, by health maintenance organizations pursuant to
 
14 this chapter, shall include benefits provided in sections
 
15 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116,
 
16 431:10A-116.5, [and] 431:10A-116.6, and 431:10A-   , and chapter
 
17 431M."
 
18      SECTION 7..  Statutory material to be repealed is bracketed.
 
19 New statutory material is underscored.
 
20      SECTION 8.  This Act shall take effect upon its approval.