The Center Joins 26 Other Organizations in Calling for Suspension of Hospice and Part D Guidance
Research suggests that medications that should be covered by the Medicare Hospice Benefit are sometimes paid for by Medicare Part D plans. In March, to prevent this from happening, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Plan Sponsors and Medicare Hospice Providers entitled, “Part D Payment for Drugs for Beneficiaries Enrolled in Hospice – Final 2014 Guidance” (Guidance). See the Center’s April 10, 2014 Alert “Hospice and Access to Medications – New CMS Guidance.” CMS’ Guidance is available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/Downloads/Part-D-Payment-Hospice-Final-2014-Guidance.pdf. The Guidance requires Part D plans to initially deny payment for all prescribed medications for hospice patients. Hospice patients will then have to appeal the denials in order to get Part D payment for their medications.
On June 11, 2014 the Center for Medicare Advocacy and 26 other organizations sent a letter to CMS Administrator Tavenner expressing concern that the Guidance places Medicare beneficiaries at the center of potential disagreements between hospice providers and Part D plans — essentially requiring dying patients to navigate payer disputes about coverage for necessary medications. The letter urges CMS to replace the Guidance with a more suitable solution.