GUIDELINES FOR THE HOSPICE BENEFIT
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Hospice Benefit Guidelines for Patients & Families The hospice benefit provides coverage for palliative, comfort-oriented care and services. A hospice benefit 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: Respite Care
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Home care visits All home care visits/services provided by the Four Seasons Care Team as well as pre-authorized ser- vices provided by your medical provider are fully covered under the benefit. Physical, occupational and speech therapy is provided based on the pa- tient’s plan of care. Medical Provider Services Visits to consulting medical providers pre-approved by the hospice team are covered when related to the ter- minal 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 equiv- alents based on Four Seasons Formulary and ap- proved substitutions. Hospitalization Although most pain and symptom management problems can be managed at home, occasionally a short hospitalization may be necessary to control symptoms. Hospitalization must be facilitated by the hospice nurse with your medical provider’s ap- proval and provided in a contracted hospital or at an inpatient hospice unit like Elizabeth House. The hos- pice 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. Supplies must be ordered by the hospice nurse and obtained from a hospice contracted supplier.
Respite Care can be provided for the caregiver by admitting the patient into an inpatient facility 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 fol- lowed by an indefinite number of sixty day peri- ods. Recertification by the hospice medical pro- vider is required at the beginning of each new benefit period, and the 3rd or later benefit pe- riods 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 provided or authorized by the Four Seasons, you may ei- ther self pay for that service or revoke the hos- pice 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 Hospice first, you may be responsible for paying the bill at the hospital.
In the midst of emotional upheaval brought on by the prolonged illness and death of a loved one, the surviving individuals confront the additional task of the complex legal, financial, and social tasks following a death. This information offers some suggestions for getting through this difficult period and a checklist of tasks. If you would like to seek the advice of an estate planning attorney, please call the Four Seasons Foundation at 828.513.2440. • The immediate need for every person is an adequate and accessible source of funds. Check with the bank to see how the death of your loved one has affected any accounts. Depending upon how these accounts have been set up, you may be able to withdraw 50%-100% of the funds before the estate is settled. The survivor’s individually held accounts are not affected. • You must decide which tasks to undertake yourself and which to leave to the professionals. This can be difficult. When in doubt, turn to your attorney, banker, tax advisor, or other trusted individual. • Dishonest people read obituary notices and prey on grieving families. Be wary of anyone offering at- tractive deals, or claiming the deceased promised or owed them money. Before you sign anything, ac- cept delivery on anything, or give money to anyone, consult your lawyer, your minister, your Care Team, or a knowledgeable and trusted friend. Top Priority Tasks Checklist Since each person’s needs differ, we suggest you place a check mark in the box to the left of those items that apply to your case, decide who is going to do each task, and put that person’s initial after that item. Enter a completion date as each task is completed. If someone has not kept a list of people who have sent food, flowers, memorials, or showed some other kindness, try to compile such a list from memory as soon as possible. Dispose of any unused drugs prescribed for the deceased. See previous sections about disposing of med- ications properly or discuss with your Care Team. Begin the process of probating the will (see Legal Tasks on right). Obtain death certificates from the funeral home and/or the Register of Deeds at the County Courthouse where the deceased person lived. You will need one for every piece of property, bank account, insurance policy, certificate of deposit (CD), individual retirement account (IRA), or other asset owned by the de- ceased. There is normally a per copy charge. Most people need about 6-10 copies. For each life insurance policy, notify the local agent of the death, and ask what procedure you need to follow. Also request a copy of Federal Form 712, which you will need later for tax purposes. If the deceased was retired and receiving a pension from the federal or state government, or from a private corporation, the payer(s) of the pension(s) should be informed of the death promptly. Ask about survivors’ benefits and continuation of health coverage. Return any pension checks payable to the deceased.
866.466.9734 • FourSeasonsCare.org
866.466.9734 • FourSeasonsCare.org
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