Who determines what Hospice will and will not cover?

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BarbBrooklyn Asked July 2015

Who determines what Hospice will and will not cover?

So, we're going to have the Hospice conversation with regards to my mom. My big question has to do with what Hospice will and will not cover. We were told months ago that they would have to remove her bp meds. Now I'm told bp meds are fine. ??

Will they cover PT if she gets strong enough to walk again? Will they provide
antibiotics if she develops a uti or pneumonia? Are there regulations and where can I read them? My mom has congestive heart failure, vascular dementia, high bp, anxiety and depression. She is recovering from pneumonia.

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score 0 · Answer 1

So I just found Medicare.gov document that outlines what's civered. It's tricky language...Hospice covers meds and therapies that help with symptoms and pain but that are not curative. Oy. This is complicated.

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score 0 · Answer 2

Windy, that's the problem. When I met with them almost a year ago (when I thought mom was ready for Hospice and the facility didn't ) I was told by the hospice RN (who is lively, and I like her) that they'd have to take mom off her bp meds. Which was unacceptable. No, the facility social worker checked and said yes, they'd be allowable. So I'd like to get some outside information . Hospice is covered by Medicare in this case, mom is private pay at the nursing home.

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score 1 · Answer 3

You will be meeting with a case management team from the hospice organization. This is usually an RN, a social worker and maybe others depending on the organization. They will be able to answer all your questions. The service is usually covered by Medicaid.

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Who determines what Hospice will and will not cover?

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