Medicare News: End-of-Life Options for Medicare Patients Detailed in New Regulation

June 5, 2008 – Medicare beneficiaries with terminal illnesses have their right to determine how they receive end-of-life care outlined for the first time in a new regulation to be published today by the Centers for Medicare & Medicaid Services.

Specifically, the rule says, patients who choose hospice, or palliative care, over curative treatment are entitled to such things as participation in their treatment plan; the right to effective pain management, the right to refuse treatment and the right to choose his or her own physician.

In the first overhaul of regulations governing the hospice industry since 1983, the new Medicare Conditions of Participation (CoP), include explicit language on patient rights that had not existed under the previous regulations.

Although many hospice patients are already active in their own treatment plans, this regulation is the first to set out a detailed list of patient rights.

“As more patients and their families come to understand and select hospice care, we felt it was critical to outline what rights patients have to control the care they receive in their final days,” said Kerry Weems, acting administrator of CMS.

“End-of-life care has changed markedly in the past 25 years and it is time to update our regulations to reflect advances in medicine and hospice industry practices as well as patient rights,” Weems added.

Electing hospice care is a decision those with terminal illnesses can make when they wish to forego further curative treatment in favor of care designed to ease pain and other symptoms. Hospice services provide comfort care to the patient and can include services for family members. Hospice services can be provided in the patient’s home or in an inpatient setting. Currently there are nearly one million Medicare beneficiaries receiving care from over 3,000 Medicare-approved hospices nationwide.

The rule reflects comments received since the publication of the proposed rule in May 2005. In addition to the new patient rights’ section, final regulation also includes:
A requirement that patient needs be initially assessed within 48 hours of electing the hospice benefit. The rule also requires that a comprehensive assessment occur within five days of electing the hospice and that updated assessments be done at least every 15 days thereafter.
A requirement that each patient receive a full drug profile that examines issues ranging from the effectiveness of current drug therapies to potential drug interactions to drug side effects. A treatment team will consult with a qualified individual, such as a pharmacist, to ensure that drugs meet the needs of every hospice patient.
A provision allowing a hospice to contract with another Medicare-certified hospice for nursing, medical social services, and counseling services under extraordinary or other non-routine circumstances, including travel of a patient outside of the hospice’s service area.
Removal of a provision requiring an inpatient facility only providing respite care to have an RN on duty 24 hours a day. The patient’s needs, acuity and plan of care will drive the nursing and staffing requirements.

The regulation, to be in the Federal Register on June 5, can be viewed at