HOUSE OF REPRESENTATIVES             H.R. NO.15            
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                     HOUSE RESOLUTION

URGING THE DEPARTMENT OF HUMAN SERVICES, MED-QUEST DIVISION,
   HEALTH CARE PROVIDERS, AND HEALTH INSURERS TO MAKE HOSPICE
   CARE AVAILABLE AND EXPEDIENTLY TO THE DYING.


 1       WHEREAS, hospice care is a service that can be delivered at
 2   home, in a free-standing unit operated by the hospice, in
 3   nursing or care homes, or even in beds set aside in acute care
 4   hospitals; and
 5   
 6       WHEREAS, a hospice is not a place, but rather a philosophy,
 7   which accepts that an illness has progressed to a terminal
 8   stage, and death cannot be avoided with aggressive medical
 9   treatment; and
10   
11       WHEREAS, the goal of a hospice is not to prolong life, but
12   to make dying as comfortable as possible for the person dying,
13   and for family and friends; and
14   
15       WHEREAS, virtually every study of hospice care has
16   concluded that:
17   
18       (1)  The primary benefit of hospice care is increased
19            patient satisfaction; and
20   
21       (2)  Hospice care almost always costs less than either
22            hospital care or other forms of acute care at the end
23            of life;
24   
25       and
26   
27       WHEREAS, a recent Gallup Survey reports that when hospice
28   care was explained, seventy percent of people, if terminally
29   ill, would want access to hospice care, yet, hospice care is
30   underutilized; and
31   
32       WHEREAS, hospice insurance does not adequately cover many
33   hospice costs; and
34   
35       WHEREAS, a hospice program is reimbursed $107 per day by
36   Medicare, whether the patient is at home or in a residential
37   facility, while Hawaii Medicaid reimburses hospice care at a
38   rate of only $103 per day in contrast to an acute care hospital
39   rate of $458 per day; and

 
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 1       WHEREAS, the average cost of residential hospice care in
 2   Hawaii is $160-$210 per day, over and above the base cost of
 3   $150 per day for at-home hospice care; and
 4   
 5       WHEREAS, hospice programs have emphasized and are often
 6   required at-home care, and currently, Medicare requires more
 7   than eighty percent of the days in each hospice to be spent in
 8   at-home care, however, many patients in need of or who could
 9   benefit from hospice services have no family members or other
10   unpaid, supportive persons who could be available around-the-
11   clock; and
12   
13       WHEREAS, improvements in the care of dying patients must
14   take place in settings other than at-home care, as most
15   Americans die in either hospitals (sixty-one percent) or
16   nursing homes (seventeen percent); and
17   
18       WHEREAS, the Governor's Blue Ribbon Panel on Living and
19   Dying with Dignity unanimously recommended, among other things,
20   that hospice care be made more available and offered more
21   expediently to the dying; now, therefore,
22   
23       BE IT RESOLVED by the House of Representatives of the
24   Twentieth Legislature of the State of Hawaii, Regular Session
25   of 1999, that the Department of Human Services, Med-QUEST
26   Division, health care providers, and health insurers are urged
27   to make hospice care available and expediently to the dying;
28   and
29   
30       BE IT FURTHER RESOLVED that the Department of Human
31   Services expand Hawaii's Medicaid benefits for hospice care for
32   anyone with a life expectancy of one year or less; and
33   
34       BE IT FURTHER RESOLVED that professional health care
35   associations develop standards or adopt existing standards
36   pertaining to full disclosure of all health care options,
37   including hospice care; and
38   
39       BE IT FURTHER RESOLVED that such standards be:
40   
41       (1)  Established and reviewed by the appropriate
42            professional boards;
43   
44       (2)  Incorporated into peer review mechanisms; and
45   

 
 
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 1       (3)  Shared with referring agencies;
 2   
 3       and
 4   
 5       BE IT FURTHER RESOLVED that Hawaii health insurance plans
 6   include:
 7   
 8       (1)  Coverage for hospice care, with the Medicare per diem
 9            rate established as the minimum rate; and
10   
11       (2)  Reimbursement for the "room and board" portion of
12            hospice facilities;
13   
14       and
15   
16       BE IT FURTHER RESOLVED that the "mutually exclusive"
17   eligibility requirement for hospice and non-hospice care be
18   eliminated; and
19   
20       BE IT FURTHER RESOLVED that health insurers recognize
21   hospice referral visits as a reimbursable benefit, whether or
22   not the referred patients are admitted to hospice; and
23   
24       BE IT FURTHER RESOLVED that long-term and extended care
25   facilities be required to have a contractual relationship with
26   a hospice service provider to allow access to these services,
27   if needed; and
28   
29       BE IT FURTHER RESOLVED that health care plans subscribing
30   to national quality assurance standards include quality of care
31   at the end of life in such areas as symptoms, function, advance
32   planning, aggressive life-extending treatments, patient
33   satisfaction, family satisfaction, quality of life, family
34   burden, survival time, provider continuity and skill, and
35   bereavement; and
36   
37       BE IT FURTHER RESOLVED that certified copies of this
38   Resolution be transmitted to the Department of Human Services,
39   the Hawaii Medical Association, the Hawaii Nurses Association,
40   the Hawaii Medical Services Association, the Queen's Health
41   Plan, Kaiser Permanente, and the Healthcare Association of
42   Hawaii.
43 
44 
45 
46                         OFFERED BY:  ____________________________

 
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