For advertising information visit www.samplerpublications.com or call 859.225.4466 | September 2014
CMS Issues Revised Guidance
on Medicare Part D for Hospice
Patients
KAHPC & Several Members of the
Kentucky Congressional Delegation
Played Crucial Role in Advocating for
Revisions
Several members of the Kentucky
Congressional Delegation joined the
Kentucky Association of Hospice
and Palliative Care (KAHPC) in
calling for a temporary halt in recent
Part D Payment Reform Guidance
issued by CMS. Specifically, Senator
Mitch McConnell, Representatives
Ed Whitfield, Brett Guthrie, John
Yarmuth, and Andy Barr co-signed
letters sent by the United States
House and United States Senate
to CMS Administrator Marilyn
Tavenner requesting that CMS suspend the current Part D payment
policy and instead bring together all
relevant stakeholders to work together on a policy that does not jeopardize Medicare beneficiaries’ access
to medication. The joint efforts of
Congressional leaders and hospice
advocates have paid off and now
hospice patients everywhere will have
timely access to needed prescription
medications.
On March 10, 2014, 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). The
Guidance, which became effective
May 1, 2014, set forth a prior authorization process aimed at limiting
instances in which a Part D plan
inappropriately covered prescription
medications related to a hospice beneficiary’s terminal condition.
When a beneficiary elects hospice under Medicare, the hospice is
required to pay for drugs associated
with terminal illness or related conditions. Part D processes the medications for conditions unrelated to
the terminal illness. This framework
means that medications that should
be covered by the Medicare hospice
benefit are sometimes incorrectly
paid for by Part D plans. Under the
prior Guidance, whenever a beneficiary or family caregiver attempted
to fill a prescription at a pharmacy,
the pharmacy was required contact
the prescriber to determine whether
the medication was related to the
terminal illness. If it was not or if the
determination of relatedness was
unclear, the pharmacy could not fill
the prescription. Instead, the pharmacy had to notify the beneficiary of his
or her appeal rights – thus placing the
burden on the beneficiary to request
a formal coverage determination from
their Part D plan to access their prescribed medication.
In effect, the Guidance placed
terminally ill patients at the center of
disagreements between hospice providers and Part D plans, leaving them
to navigate payer disputes on their
own – a battle for which they had neither the time nor strength.
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Recognizing this problem, KAHPC
joined forces with hospice providers across the nation and went to
Washington, D.C. to rally for change.
Specifically, KAHPC met with the
Kentucky Congressional delegation
and informed them about the hugely
detrimental impact the Guidance was
having on hospice patients and their
families.
The united front was successful.
On July 18, 2014, CMS issued a new
memorandum, which now limits
prior authorization by hospices to
four classes of drugs: analgesics,
antinauseants, laxatives, and antianxiety medications. According to the
HHS Inspector General, these drugs
are nearly always covered under the
Medicare hospice benefit.
On behalf of the hospice providers
across Kentucky and the patients they
serve, KAHPC would like to sincerely
thank the Kentucky Members of
Congress who co-signed the letters
to Administrator Tavenner. Because
of your support, hospice patients can
now rest a little easier.