REPORT TITLE:
Hospice Care Reimbursement


DESCRIPTION:
Requires health insurers to cover hospice care.  Allows hospice
homes in areas zoned for residential use.  Allows department of
health to license hospice service agencies and sets general
parameters for such licensing.  Requires director of health to
adopt rules.  (HB172 SD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 1
TWENTIETH LEGISLATURE, 1999                                S.D. 2
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO HOSPICE SERVICES.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  The blue ribbon panel on living and dying with
 
 2 dignity was formed by the governor in late 1996 to consider the
 
 3 many issues involved in death and dying and to suggest guidelines
 
 4 for public policy.  In May 1998, the blue ribbon panel issued its
 
 5 final report and made seven recommendations, six of which were
 
 6 made unanimously.  The fourth unanimous recommendation recommends
 
 7 that hospice care be made more available and offered more
 
 8 expediently to the dying.
 
 9      Hospice care is not a place.  It is a service that can be
 
10 delivered at home, in a freestanding unit operated by the
 
11 hospice, in nursing or care homes, or even in beds set aside in
 
12 acute care hospitals.  Hospice care is a philosophy which accepts
 
13 that an illness has progressed to a terminal stage, and death
 
14 cannot be avoided even with aggressive medical treatment.  The
 
15 goal of hospice care is not to prolong life, but to make dying as
 
16 comfortable as possible for the person dying, and for family and
 
17 friends.  The blue ribbon panel found that many of Hawaii's
 
18 health care providers believe that if pain management can be
 
19 improved and hospice care increased, few people would consider
 

 
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 1 physician-assisted death, which may be viewed as desirable when
 
 2 pain is not controlled and when the patient foresees being in a
 
 3 sterile or strange hospital or other residential program, rather
 
 4 than dying at home in the presence of loved ones.
 
 5      The legislature finds that hospice care not only increases
 
 6 patient satisfaction but also almost always costs less than
 
 7 either hospital care or other forms of acute care at the end of
 
 8 life.  Yet, hospice care is underutilized.  Each year, of eight
 
 9 thousand deaths in Hawaii, five thousand could have benefitted
 
10 from hospice care, yet only about one thousand five hundred
 
11 persons received hospice care.
 
12      According to the blue ribbon panel, the Medicare per diem
 
13 rate of $107 would establish a floor but this rate would still
 
14 not allow hospice providers to recover their full costs amounting
 
15 to $160 to $210 per day in room and board costs.  If this
 
16 additional cost were reimbursed, it would still be lower than the
 
17 $458 per diem Medicaid reimbursement for similar costs in acute
 
18 care hospitals.
 
19      The blue ribbon panel also specifically recommended making
 
20 hospice referral visits a reimbursable benefit regardless of
 
21 whether a patient is eventually admitted to a hospice or not.
 
22 Implementing this recommendation would go a long way towards
 
23 encouraging greater use of hospice care on a timely basis.
 

 
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 1      The purpose of this Act is to implement two specific
 
 2 recommendations made by the blue ribbon panel regarding hospice
 
 3 care:
 
 4      (1)  To make the Medicare per diem rate, the current rate
 
 5           set by the Health Care Financing Administration, the
 
 6           base rate for hospice care and to additionally
 
 7           reimburse room and board expenses of hospice
 
 8           facilities; and
 
 9      (2)  To make hospice referral visits a reimbursable benefit
 
10           at the rate under paragraph (1) regardless of whether a
 
11           patient is eventually admitted to a hospice or not.
 
12      SECTION 2.  Chapter 46, Hawaii Revised Statutes, is amended
 
13 by adding a new section to be appropriately designated and to
 
14 read as follows:
 
15      "46-    Hospice homes; permitted use in residential areas.
 
16 For purposes of section 46-4, a hospice home shall be considered
 
17 a residential use of property and shall be a permitted use in
 
18 residentially designated zones, including but not limited to,
 
19 zones for single-family dwellings.  No conditional use, permit,
 
20 variance, or special exception shall be required for a residence
 
21 used as a hospice home.
 
22      For purposes of this section, "hospice home" means any
 
23 facility operated by a licensed hospice service agency providing
 

 
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 1 twenty-four hour living accommodations to no more than five
 
 2 unrelated persons who are admitted to the hospice program of
 
 3 care."
 
 4      SECTION 3.  Chapter 321, Hawaii Revised Statutes, is amended
 
 5 by adding a new section to be appropriately designated and to
 
 6 read as follows:
 
 7      "321-     Hospice services.  (a)  The department of health
 
 8 may license hospice service agencies.  If the department licenses
 
 9 hospice service agencies, the director shall adopt rules in
 
10 accordance with chapter 91 regarding hospice service agencies
 
11 that shall:
 
12      (1)  Protect the health, safety, welfare, and civil rights
 
13           of persons residing in their place of residence; and
 
14      (2)  Provide penalties for the failure to comply with any
 
15           rule.
 
16      (b)  For the purposes of subsection (a), licensing shall be
 
17 required annually for the first two years of licensure.
 
18 Thereafter, licensing shall be biennial; provided that if the
 
19 department of health receives a complaint regarding the hospice
 
20 service agency from the time of the last licensure, the licensing
 
21 shall be annual until such time as the department is satisfied
 
22 that licensing may proceed biennially.
 
23      (c)  For the purpose of this section:
 

 
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 1      "Hospice home" means any facility operated by a licensed
 
 2 hospice service agency providing twenty-four hour living
 
 3 accommodations to no more than five unrelated persons who are
 
 4 admitted for hospice service.
 
 5      "Hospice service" means a program of palliative and
 
 6 supportive care for terminally ill persons and their families or
 
 7 caregivers.
 
 8      "Hospice service agency" means an agency or organization, or
 
 9 a subdivision of that agency or organization, which is engaged in
 
10 providing hospice services at the place of residence of its
 
11 clients."
 
12      SECTION 4.  Section 321-15.7, Hawaii Revised Statutes, is
 
13 amended to read as follows:
 
14      "321-15.7  Penalty.  Any person who intentionally operates
 
15 an adult residential care home or hospice home without a license
 
16 shall be guilty of a misdemeanor."
 
17      SECTION 5.  Chapter 431, Hawaii Revised Statutes, is amended
 
18 by adding a new section to article 10A to be appropriately
 
19 designated and to read as follows:
 
20      "431:10A-     Hospice care coverage.  (a)  Any other law to
 
21 the contrary notwithstanding, commencing on January 1, 2000, all
 
22 authorized insurers that provide for payment of or reimbursement
 
23 for hospice care, shall reimburse hospice care providers for each
 

 
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 1 insured policyholder covered for hospice care according to the
 
 2 following schedule:
 
 3      (1)  A minimum daily rate as set by the Health Care
 
 4           Financing Administration for hospice care; and
 
 5      (2)  An amount of $     per day for room and board expenses
 
 6           directly related to the hospice care being provided in
 
 7           excess of the rate in paragraph (1).
 
 8 In addition, each hospice referral visit during which a patient
 
 9 is advised of hospice care options shall be considered a
 
10 reimbursable benefit regardless of whether the referred patient
 
11 is eventually admitted to hospice care.
 
12      (b)  Every insurer shall provide notice to its policyholders
 
13 regarding the coverage required by this section.  The notice
 
14 shall be in writing and prominently positioned in any literature
 
15 or correspondence sent to policyholders and shall be transmitted
 
16 to policyholders annually, beginning with calendar year 1999
 
17 along with any other mailing to policyholders, but in no case
 
18 later than December 31, 1999."
 
19      SECTION 6.  Chapter 432:1, Hawaii Revised Statutes, is
 
20 amended by adding a new section to be appropriately designated
 
21 and to read as follows:
 
22      "432:1-    Hospice care coverage.  (a)  Any other law to
 
23 the contrary notwithstanding, commencing on January 1, 2000, all
 

 
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 1 mutual benefit societies issuing or renewing an individual and
 
 2 group hospital or medical service plan, policy, contract, or
 
 3 agreement in this State that provides for payment of or
 
 4 reimbursement for hospice care, shall reimburse hospice care
 
 5 providers for each insured member covered for hospice care
 
 6 according to the following schedule:
 
 7      (1)  A minimum daily rate as set by the Health Care
 
 8           Financing Administration for hospice care; and
 
 9      (2)  An amount of $     per day for room and board expenses
 
10           directly related to the hospice care being provided in
 
11           excess of the rate in paragraph (1).
 
12 In addition, each hospice referral visit during which a patient
 
13 is advised of hospice care options shall be considered a
 
14 reimbursable benefit regardless of whether the referred patient
 
15 is eventually admitted to hospice care.
 
16      (b)  Every insurer shall provide notice to its members
 
17 regarding the coverage required by this section.  The notice
 
18 shall be in writing and prominently positioned in any literature
 
19 or correspondence sent to members and shall be transmitted to
 
20 members annually, beginning with calendar year 1999 along with
 
21 any other mailing to members, but in no case later than December
 
22 31, 1999."
 
23      SECTION 7.  Section 432D-23, Hawaii Revised Statutes, is
 

 
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 1 amended to read as follows:
 
 2      "[[]432D-23[]]  Required provisions and benefits.
 
 3 Notwithstanding any provision of law to the contrary, each
 
 4 policy, contract, plan, or agreement issued in the State after
 
 5 January 1, 1995, by health maintenance organizations pursuant to
 
 6 this chapter, shall include benefits provided in sections
 
 7 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116,
 
 8 431:10A-116.5, [and] 431:10A-116.6, and 431:10A-   , and chapter
 
 9 431M."
 
10      SECTION 8.  Statutory material to be repealed is bracketed.
 
11 New statutory material is underscored.
 
12      SECTION 9.  This Act shall take effect upon its approval.