REPORT TITLE:
Medicaid Hospice Benefits


DESCRIPTION:
Requires DHS to submit a request for a waiver from the Health
Care Financing Administration to allow Hawaii Medicaid benefits
for hospice care to any person with a life expectancy of one year
or less.  Appropriates $        in both FY 1999-2000 and FY 2000-
2001.  Upon approval except 7/1/99 for appropriations.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        
THE SENATE                              S.B. NO.           850
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT
RELATING TO MEDICAID HOSPICE CARE BENEFITS.



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
 
 5 its final report and made seven recommendations, six of which
 
 6 were made unanimously.  The fourth unanimous recommendation
 
 7 recommends that hospice care be made more available and offered
 
 8 more 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 asserts that if pain management
 
18 can be improved and hospice care increased, many of Hawaii's
 
19 health care providers believe that few people would consider
 

 
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                                     S.B. NO.           850
                                                        
                                                        

 
 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      The legislature also finds that Medicare benefits for
 
13 hospice care is provided only if a patient is eligible for
 
14 Medicare Part A, the patient's doctor and the hospice medical
 
15 director certify that the patient is terminally ill, the patient
 
16 signs a statement choosing hospice care in lieu of standard
 
17 Medicare benefits for the terminal illness, and the patient
 
18 receives care from a Medicare-approved hospice program.  Patients
 
19 who accept hospice care are initially eligible for ninety days of
 
20 Medicare hospice care benefits, renewable for an additional
 
21 ninety days.  If necessary, eligibility can be renewed for an
 
22 unlimited number of additional sixty-day periods if the patient
 

 
 
 
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                                     S.B. NO.           850
                                                        
                                                        

 
 1 is certified terminally ill at the beginning of each period.  The
 
 2 problem lies in the difficulty that many physicians feel in
 
 3 predicting a person's remaining life expectancy within six
 
 4 months.  The legislature finds that the six-month criterion is
 
 5 artificial, serves little purpose, and may even unnecessarily
 
 6 delay the admittance of terminally ill patients to hospice care.
 
 7 The legislature further finds that Medicaid expenditures for
 
 8 hospice care have been minimal and amounted to only $316,273 and
 
 9 $310,660 in fiscal years 1995 and 1996, respectively.  A modest
 
10 expansion of hospice benefits should not be a burden to the
 
11 State.
 
12      The purpose of this Act is to implement the blue ribbon
 
13 panel's specific recommendation to allow Hawaii Medicaid benefits
 
14 for hospice care for any person with a life expectancy of one
 
15 year or less.
 
16      SECTION 2.  The department of human services shall prepare
 
17 and submit by June 30, 1999, a request to the Health Care
 
18 Financing Administration of the United States Department of
 
19 Health and Human Services for a waiver to allow Hawaii Medicaid
 
20 benefits for hospice care for any person having a life expectancy
 
21 of one year or less.  Upon receipt of a waiver authorization, the
 
22 department of human services shall extend hospice care Medicaid
 

 
 
 
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                                     S.B. NO.           850
                                                        
                                                        

 
 1 benefits to any person with a life expectancy of one year or
 
 2 less.
 
 3      SECTION 3.  There is appropriated out of the general
 
 4 revenues of the State of Hawaii the sum of $              , or so
 
 5 much thereof as may be necessary for fiscal year 1999-2000, and
 
 6 the same sum, or so much thereof as may be necessary for fiscal
 
 7 year 2000-2001, for Hawaii Medicaid benefits for hospice care as
 
 8 provided in this Act.
 
 9      SECTION 4.  The sums appropriated shall be expended by the
 
10 department of human services for the purposes of this Act.
 
11      SECTION 5.  This Act shall take effect upon approval, except
 
12 that sections 3 and 4 shall take effect on July 1, 1999.
 
13 
 
14                              INTRODUCED BY:______________________