Revised NAHC/HAA Tools for Hospice and Part D Coordination Now Available Online
July 24, 2014 12:40 PM
On July 18, 2014 the Centers for Medicare & Medicaid Services (CMS) released a memorandum, Part D Payment for Drugs for Beneficiaries Enrolled in Medicare Hospice, which updates the guidance previously released in March. Under the new guidance, in lieu of placing a beneficiary-level prior authorization (PA) on all drugs for beneficiaries who have elected hospice, CMS strongly encourages Part D sponsors to place beneficiary-level PA requirements on only four categories of prescription drugs: analgesics, antinauseants (antiemetics), laxatives, and antianxiety drugs (anxiolytics).
The National Association for Home Care & Hospice (NAHC) and other stakeholders were actively involved in efforts to address the numerous issues related to CMS’ previous across-the-board PA requirement that created challenges for hospice patients in accessing needed prescription medications.
NAHC’s Hospice Association of America (HAA) has revised previously developed tools to assist member organizations as they implement processes to help patients ensure timely access to prescribed drugs. Following is a list of items now available on the NAHC website - under Hospice Regulatory Resources tab - for use by member organizations:
Part D PA Process Explanation
--provides background on the process Part D plans and hospices are encouraged to use to establish appropriate coverage responsibility for prescription drugs for hospice patients that fall within the four categories listed above.
Hospice and Part D – Questions and Answers -- answers to members’ frequently asked questions.
Part D PA Process -- Tips -- suggestions to help ensure compliance with Part D PA requirements.
Part D PA Process Sample Admission Notice -- a sample admission notice that includes an explanation of the Part D PA process.
Also included in Hospice Regulatory Resources are key documents issued by CMS related to coordination of benefits between Part D and hospice. It is anticipated that CMS will be issuing additional information related to the revised Part D/hospice policies in the near future; updates will be provided as they occur in NAHC Report, Hospice Notes, and on the NAHC member listserv.