Home Health and Hospice - Essay Example

Medicare is composed of three parts; Part A, Part B, and most recently part D. Part A and B were the initial divisions of the Medicare Program. Part A covers the health care received in hospice and health care without monthly premiums. It is the insurance portion of Medicare. Part B covers doctors’ services as well as other outpatient care absent in part A with an added monthly premium, which in 2008 cost about $96.40 every month (Shi & Singh, 2010). Changes in payment permitted people to make hospice services payment on a prospective basis under four care levels and adjusted by the wage index in an area.

The local adjustment was important because it allowed low rates in regions with low wage levels and high rates in regions with high wage levels. This was followed by a new wage index, which comprised of a mix of both new and old wage indexes however; the new index was still based on hospital wage data. The Medicare hospice rates also varied according to the level of care that a beneficiary received. Initially, the payment system by Medicare was linked to the “Balanced Budget Act of 1997 (BBA)”, and it had a huge influence on the number of home health as well as hospice care agencies.

Initially, the implementation of BBA led to the exit of these agencies from the market as it reduced medical reimbursement, and the number of providers. Implementation of the prospective payment system (PPS) generated improved growth and financial stability of agencies. It stopped the decline in the number of home health providers. With the PPS, Medicare paid home health and hospice providers for every 60-day “episode of care.” The amount paid for the 60-day period was a set amount based on a standard rate and adjusted to the type as well as the intensity of care offered known as a case mix formula.

The home health PPS depended on a 153-category case mix adjuster to set payment rates anchored in patients attributes like functional status, clinical rigorousness, and the requirement for rehabilitative therapy examinations (Shi & Singh, 2010). Initially, Medicare hospice coverage consisted of 290-day benefit periods and an indefinite number of 60-day benefit time. Coverage can extend beyond this period given that a six-month prognosis is the doctor’s best estimate. There is also provision for patients to move out of and back into hospice care.

When out of the care, patients regular Medicare or other insurance cover them. Medicare reimburses the providers of home health and hospice care on a per diem basis. This kind of payment covers all services offered by the hospice (Shi & Singh, 2010). There are numerous different rates that vary according to the level and type of care offered. Concerning eligibility for home and health care under Medicare, a patient has to present a medical justification to qualify hospice and home health benefits.

Initially, eligibility criteria varied, depending on the hospice program. However, patients had to have a progressive, irreversible illness limited life expectancy, and they had to opt for palliative care instead of cure-focussed treatment. The presence of a family member or another caregiver was required continuously when the patient was no longer able to care for him or herself. Initially, for a person to be qualified for Medicare benefits, he or she had to be qualified f