Adviser LeadingAge New York Winter 2014 Winter 2014 | Page 37

are coverable under Part D. In July,
CMS revised this guidance to cover
only four classes of medications:
analgesics, antinauseants
(antiemetics), laxatives, and
antianxiety drugs (anxiolytics).
Hospice providers are responsible
for coordinating with the Part
D plans for those drugs they
believe are completely unrelated
to the terminal illness and related
condition to determine payment
responsibility. The hospice
provider or prescriber immediately
provides the Part D plan with
written documentation necessary
to satisfy their prior approval
process. Currently, there is not
a review process in place, but
rather, the determination of the
prescribing physician as to whether
or not the medications are related
to the terminal documentation, is
the final word.
Although there was significant
confusion when the process
first rolled out, Medicare Part D
plans have generally been very
cooperative once a definitive
process is in place with the hospice
providers. For many years hospice
programs have been working
in close collaboration with
nursing homes to offer holistic,
interdisciplinary end of life care
to Nursing home residents and

their families. As hospices take the
lead in coordinating the Part D
benefit components, the new prior
authorization process should not
cause disruption or risk for nursing
home partners.

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