A common misconception about hospice is that it is a service provided only to cancer patients. The fact is that we provide care to patients with any end stage diagnosis. These may include, but are not limited to:
Is it true that you must have only six months to live to be eligible for the Medicare Hospice Benefit? Another common, and unfortunate, misconception about hospice is that the use of hospice care somehow guarantees the patient has less than six months to live. Medicare defines the hospice standards that are used by Medicare hospice providers, Texas hospice providers and most private insurance companies. Medicare has provided the following explanation and clarification regarding the hospice benefit eligibility guidelines. “Generally speaking, the hospice benefit is intended primarily for use by patients whose prognosis is terminal, with six months or less life expectancy. [However], the Medicare program recognizes that terminal illnesses do not have entirely predictable courses.” “Recognizing that prognoses can be unpredictable and may change, Medicare’s benefit is not limited in terms of time. Hospice care is available as long as the patient’s prognosis meets the law’s six month test. This test is a general one……based on the [attending] physician’s and/or Medical Director’s clinical judgment regarding the normal course of the individual’s illness. Medicare recognizes that making medical prognostications of life expectancy is not always an exact science.” Under this philosophy, Medicare has specified a procedure for certification and periodic recertification of the patient’s eligibility for care under the Medicare Hospice Benefit. This procedure provides two 90-day eligibility certification periods followed by an UNLIMITED number of 60-day eligibility certification periods. As long as the patient, in the judgment of the primary physician and hospice Medical Director, continues to meet the six month criteria during each certification period, the patient can continue to receive care under the Medicare Hospice Benefit. When does hospice care become appropriate? Hospice care becomes appropriate when an individual has a life-limiting illness or condition. The patient's primary physician and the Autumn Journey Hospice Medical Director will work together to make this medical determination. The patient and family then determine whether the patient wishes to enter the hospice care program. The following guidelines are used to assist the physician and hospice Medical Director in making a judgment regarding an individual's eligibility for hospice care. The patient has a declining functional status as determined by either:
We have also prepared the following brief questionnaire that can help you determine whether hospice care is right for you or your loved one. Informal Hospice Eligibility Questionnaire You or your loved one may be eligible for hospice care if you check 4 or more statements. However, your primary physician and our Medical Director will make the final decision regarding eligibility. Please check the following statements as they apply to you or your loved one to see if hospice care may be appropriate.
Autumn Journey Hospice
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Who is eligible for hospice care? 