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New Federal Regulations Affect Nursing Homes, Hospices

Long-term facilities such as skilled nursing homes or facilities for people with intellectual disabilities often work with hospices. In some cases it goes well. But in other cases, communication can go by the wayside, affecting quality of patient care.

New federal regulations from the Centers for Medicare and Medicaid hope to smooth the transition between the facilities as well as give the patient more choice.

They went into effect on Monday. 

Patients in long-term care facilities basically now have two options:

  • Option 1: They can arrange for hospice services through an agreement with one or more Medicare-certified hospices.  
  • Option 2: They can not arrange for hospice services at the facility they are at, and the facility has to assist the patient by transferring them to a facility that will arrange for the provision of hospice services when the patient requests that transfer.

"What it translates to for the patients and families that have a loved one residing in a nursing facility is that they cannot be denied access to care by regulation," said Barbara Ivanko, president and CEO of Family Hospice and Palliative Care, one of hundreds of hospices in Pennsylvania. "By regulation, the nursing facility has to make sure that they are provided with care by the hospice of their choice even if that facility they themselves cannot provide it."
These new rules are meant to work with rules from 2008 that established program requirements for hospices that provide hospice services to those at long-term care facilities.

There are other requirements in the contracts — that the hospice specify what services they’ll provide, including medical direction and management of the patient, nursing, counseling, medical supplies, medications and whatever else is needed to alleviate pain associated with terminal illness.

And there will be authorized contracts written before the patient enters hospice care specifying the role and responsibility of each entity.

Franco Insana, chief financial officer at Family Hospice and Palliative Care, said the rules have not always been so clear.

"The Medicare regulations have been somewhat unclear," he said. "Medicare regulations have several sections. There's a section for instance that speaks solely to the requirements of hospices, another section that speaks to the requirements of skilled nursing facilities; there's another section for hospitals, etc., and I think over time, those parts of the regulation have evolved and created some confusion."

Occasionally this lack of clarity led to a decay in quality.

"Hospice providers and skilled nursing facilities were not always on the same page," he said. "In some cases there were duplication of services, and in some cases there were gaps."

Some hospices already have contracts in place with long-term care facilities that comply with these new conditions. Now they all will.

Erika Beras (she/her) is a reporter and host for NPR's Planet Money podcast.