Assessment of Levels of Hospice Care Coverage Offered to Commercial Managed Care Plan Members in California

Abstract

The implementation of the Affordable Care Act that provides for the expansion of affordable insurance to uninsured individuals and small businesses, coupled with the provision of mandated hospice coverage, is expected to increase the enrollment of the terminally ill younger population in hospice care. We surveyed health insurance companies that offer managed care plans in the 2014 California health insurance exchange and large hospice agencies that provided hospice care to privately insured patients in 2011. Compared with Medicare and Medicaid hospice benefits, hospice benefits for privately insured patients, particularly those enrolled in managed care plans, varied widely. Mandating hospice care alone may not be sufficient to ensure that individuals enrolled in different managed care plans receive the same level of coverage.

Keywords

hospice mandated hospice benefit affordable care act contract with a managed care plan health insurance exchange

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References

Jackson

Gibson

Staeheli

. Hospice Benefits and Utilization in the Large Employer Market. Washington, DC: The Medstat Group; 2000.

Medicare Hospice Conditions of Participation. 42 C.F.R. Short-Term Inpatient Care (§ 418.108).

South Carolina Department of Health and Human Service. Section 2: Policies and Procedures. Hospice Services Provider Manual; 2012.

What key dates do I need to know? HealthCare.gov website. https://www.healthcare.gov/what-key-dates-do-i-need-to-know/. Accessed September 10, 2013.

California Health Benefits Review Program. Issue Brief: California’s State Benefit Mandates and the Affordable Care Act’s Essential Health Benefits. Oakland, CA: California Health Benefits Review Program; 2011.

Covered California. Health Insurance Companies and Plan Rates for 2014: Making the Individual Market in California Affordable. West Sacramento, CA: Covered California; 2013.

Hospice and palliative care practice group. Standards for Hospice Managed Care. Madison, WI: Hospice and palliative care practice group; 2001.

Kaiser Permanente. Health Maintenance Organization: Combined Evidence of Coverage and Disclosure From for the Basic Plan. Oakland, CA: Kaiser Permanente; January 1, 2013.

Blue Shield of California. Health Maintenance Organization Access+HMO: Combined Evidence of Coverage and Disclosure From for the Basic Plan. San Francisco, CA: Blue Shield of California; January 1, 2013.

10.

Anthem Blue Cross. PERS Choice Basic Plan Preferred Provider Organization Evidence of Coverage. Anthem Blue Cross; Effective January 1, 2013-December 31, 2013.

11.

California Office of Statewide Health Planning & Development. Long-Term care facilities listing, licensed as of June 30, 2013. Healthcare Information Division. http://www.oshpd.ca.gov/hid/Products/Listings.html . Accessed May 20, 2013.

12.

National Home and Hospice Care Survey. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/nhhcs.htm. Accessed March 13, 2013.

13.

Medicare Payment Advisory Commission (MedPac). Report to the Congress: Medicare Payment Policy. Chapter 11 Hospice Services. Washington DC: Medicare Payment Advisory Commission (MedPac); 2013.

14.

Miller

Kinzbrunner

Pettit

Williams

. How does the timing of hospice referral influence hospice care in the last days of life? J Am Geriatr Soc. 2003;51(6):798–806.

15.

Casalino

Nicholson

Gans

. What does it cost physician practices to interact with health insurance plans? Health Aff (Millwood). 2009;28(4):w533–w543.

16.

American Medical Association. Standardization of Prior Authorization Process for Medical Services: White Paper. Chicago, IL: American Medical Association; 2011.

17.

Randal

. Hospice services feel the pinch of managed care. J Natl Cancer Inst. 1996;88(13):860–862.