Does Hospice Care Differ by State?

hospice differences state

No matter what state you live in, the standards and basics of hospice care are similar no matter what hospice provider. This is because hospice care is covered by Medicaid and Medicare, which are federally-regulated programs; due to this, there are certain standards of care that must be maintained across state lines. Private insurance and veteran’s benefits also typically cover hospice care.

This includes physician care, nurse and nurse aide assistance, physical, occupational or speech therapists, social workers, spiritual guidance and more. These services are provided to the patient, and in the cases of social workers and clergy members, to family and loved ones as well.

But there are some differences in hospices state-by-state, particularly in how the government pays for certain services. All states are required to offer at least 210 days of hospice care. There are also four different levels of hospice care covered by Medicare: routine home care, continuous home care, inpatient respite care and general inpatient care.

Majority of states have a fee for service system under Medicare and Medicaid where doctors and health care providers are paid for each service performed. This means care is “unbundled” and every medication, test, doctor’s visit and more are billed separately. This model is almost always used with private insurance companies as well.

States such as Arizona, California and Nevada all use the fee for service model.

Some states also charge a copay for hospice services, $2 a day in the case of Florida. Additionally, they also use a fee for service model, but Medicare reimburses the facility at 80% of the physician fee. Illinois also reimburses facilities with a fee for service at the physician’s fee model.

Georgia uses the Centers for Medicare and Medicaid Service’s Resource Based Relative Value Scale (RBRVS) rates for reimbursement. The RBRVS is centered on the idea that payments for doctor and other health services should vary with the resource costs for providing those services. It’s meant to improve the payment system while giving doctors a way to improve it as care changes and evolves.

Some states require pre-approval by Medicaid for certain services, such as pain management (Iowa) and surgeries (North Carolina and Oregon).

The differences between actual hospice care are more on a facility-by-facility basis rather than geographical differences. Visiting a potential hospice center or meeting with various home health workers can help you find both a facility and staff that you feel comfortable entrusting them with you or your loved ones’ care.

Each state typically also has some kind of statewide hospice association that can help you find centers and care that fit your needs. California has the California Hospice and Palliative Care Association, which not only has the regulations of state hospice care, but also an extensive searchable list of care options, where you can find both for profit and nonprofit facilities. You can also see which ones accept Medicare and Medicaid.

The National Hospice and Palliative Care Organization has a more extensive search feature, where you can see if a facility has state accreditation, number of beds, whether or not it has pediatric hospice services and more.

These resources can help you find hospices in your area and provide the details to help you and your loved ones find the best possible care in your state and city.

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