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MA Carve-In Could Forego 6-Month Prognosis Rule for Hospice

Posted on Monday, August 19, 2019 3:13 AM

Earlier this year, CMS announced that they would test hospice coverage through Medicare Advantage plans starting in 2021.  This carve-in is being added so that patients have greater access to hospice service and create better coordination for a patient’s hospice provider and their other healthcare providers. 

“I do think that the six-month requirement will go away if Medicare Advantage plans want an integrated product,” Mary Ann Boccolini, president and CEO of New Jersey-based Samaritan Healthcare & Hospice, told Hospice News. “It would be a continuum of care and wouldn’t be siloed like it is now. Now a person receives treatment in the acute phase, and then they go to palliation, then goes to hospice when they have a six-month terminal prognosis. I don’t think those strict divisions will be in a Medicare Advantage plan; it would just be a continuum.” 

Two physicians need to certify that a patient is expected to pass away within the next six months; most feel entrance to hospice should be based on need, not on a time frame.

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