GUIDELINES FOR THE HOSPICE BENEFIT
34
Patient/family guidelines for the hospice benefit The hospice benefit provides coverage for palliative, comfort-oriented care and services. A hospice ben - efit is provided by Medicare, Medicaid, and some private insurances. The hospice nurse can determine if you are eligible for one of the benefits. The following services are covered by a hospice benefit when pre-authorized by the hospice team: Home care visits
Respite Respite care can be provided for the caregiver by admitting the patient into an inpatient facil - ity like Elizabeth House or a nursing home or where Four Seasons has a contract. Respite care can be provided for up to five days. Benefit periods There are two (2) ninety day benefit periods followed by an indefinite number of sixty day periods. Recertification by the hospice medical provider is required at the beginning of each new benefit period, and the 3rd or later benefit periods require a face-to-face evaluation by a Four Seasons medical provider. Pre-authorization All health care services must be pre-authorized by Four Seasons to be covered under the hos- pice benefit. If you elect to receive medical or hospital services which are not directly pro- vided or authorized by the Four Seasons, you may either self pay for that service or revoke the hospice benefit. Re-election of the hospice benefit is available. CALL HOSPICE FIRST before calling 911 or taking the patient to the hospital. If you do not call Hos- pice first, you may be responsible for paying the bill at the hospital.
All home care visits/services provided by the Four Seasons Care Team as well as pre-author- ized services provided by your medical provider are fully covered under the benefit. Physical, occupational and speech therapy is provided based on the patient’s plan of care. Medical Provider Services Visits to consulting medical providers pre-ap - proved by the hospice team are covered when related to the terminal illness. Attending medical provider services are covered under Medicare Part B if the medical provider is not employed by hospice. Medications Pre-authorized medications that are related to the diagnoses for which hospice care is being rendered to you are fully covered. A list will be provided to you. Prescriptions will be filled with generic equivalents based on Four Seasons Formulary and approved substitutions. Hospitalization Although most pain and symptom management problems can be managed at home, occasion- ally a short hospitalization may be necessary to control symptoms. Hospitalization must be facilitated by the hospice nurse with your medical provider’s approval and provided in a contracted hospital or at an inpatient hospice unit like Elizabeth House. The hospice nurse will provide you with specific information and directions if hospitalization is needed. Supplies Supplies that are pre-authorized by the hospice nurse and are related to the terminal illness for which hospice is needed are fully covered. Sup- plies must be ordered by the hospice nurse and obtained from a hospice contracted supplier.
FourSeasonsCare.org
866.466.9734
Four Seasons
Made with FlippingBook - Online catalogs