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 CD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        172
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 1
TWENTIETH LEGISLATURE, 1999                                S.D. 2
STATE OF HAWAII                                            C.D. 1
                                                        
                                                             
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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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                                     H.B. NO.           H.D. 1
                                                        S.D. 2
                                                        C.D. 1
                                                        

 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 these
 
16 additional costs were reimbursed, it would still be lower than
 
17 the $458 per diem Medicaid reimbursement for similar costs in
 
18 acute 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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                                     H.B. NO.           H.D. 1
                                                        S.D. 2
                                                        C.D. 1
                                                        

 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           regardless of whether a patient is eventually admitted
 
11           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 zones
 
19 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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                                     H.B. NO.           H.D. 1
                                                        S.D. 2
                                                        C.D. 1
                                                        

 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      Licensing shall be required annually for the first two years
 
17 of licensure.  Thereafter, licensing shall be required
 
18 biennially; provided that if the department of health receives a
 
19 complaint regarding the hospice service agency from the time of
 
20 the last licensure, the licensing shall be required annually
 
21 until such time as the department is satisfied that licensing may
 
22 proceed biennially.
 

 
 
 
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                                     H.B. NO.           H.D. 1
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1      (b)  For the purpose of this section:
 
 2      "Hospice service" means a program of palliative and
 
 3 supportive care for terminally ill persons and their families or
 
 4 caregivers.
 
 5      "Hospice service agency" means an agency or organization, or
 
 6 a subdivision of that agency or organization, which is engaged in
 
 7 providing hospice services at the place of residence of its
 
 8 clients."
 
 9      SECTION 4.  Chapter 431, Hawaii Revised Statutes, is amended
 
10 by adding a new section to article 10A to be appropriately
 
11 designated and to read as follows:
 
12      "�431:10A-     Hospice care coverage.  (a)  Any other law to
 
13 the contrary notwithstanding, commencing on January 1, 2000, all
 
14 authorized insurers that provide for payment of or reimbursement
 
15 for hospice care, shall reimburse hospice care services for each
 
16 insured policyholder covered for hospice care according to the
 
17 following:
 
18      (1)  A minimum daily rate as set by the Health Care
 
19           Financing Administration for hospice care;
 
20      (2)  Reimbursement for residential hospice room and board
 
21           expenses directly related to the hospice care being
 
22           provided; and
 

 
 
 
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                                     H.B. NO.           H.D. 1
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1      (3)  Reimbursement for each hospice referral visit during
 
 2           which a patient is advised of hospice care options,
 
 3           regardless of whether the referred patient is
 
 4           eventually admitted to hospice care.
 
 5      (b)  Every insurer shall provide notice to its policyholders
 
 6 regarding the coverage required by this section.  Notice shall be
 
 7 in writing and in literature or correspondence sent to
 
 8 policyholders, beginning with calendar year 2000, along with any
 
 9 other mailing to policyholders, but in no case later than
 
10 July 1, 2000."
 
11      SECTION 5.  Chapter 432, Hawaii Revised Statutes, is amended
 
12 by adding a new section to article 1 to be appropriately
 
13 designated and to read as follows:
 
14      "�432:1-    Hospice care coverage.  (a)  Any other law to
 
15 the contrary notwithstanding, commencing on January 1, 2000, all
 
16 mutual benefit societies issuing or renewing an individual and
 
17 group hospital or medical service plan, policy, contract, or
 
18 agreement in this State that provides for payment of or
 
19 reimbursement for hospice care, shall reimburse hospice care
 
20 services for each insured member covered for hospice care
 
21 according to the following:
 
22      (1)  A minimum daily rate as set by the Health Care
 
23           Financing Administration for hospice care;
 

 
Page 7                                                     172
                                     H.B. NO.           H.D. 1
                                                        S.D. 2
                                                        C.D. 1
                                                        

 1      (2)  Reimbursement for residential hospice room and board
 
 2           expenses directly related to the hospice care being
 
 3           provided; and
 
 4      (3)  Reimbursement for each hospice referral visit during
 
 5           which a patient is advised of hospice care options,
 
 6           regardless of whether the referred patient is
 
 7           eventually admitted to hospice care.
 
 8      (b)  Every insurer shall provide notice to its members
 
 9 regarding the coverage required by this section.  Notice shall be
 
10 in writing and in literature or correspondence sent to members,
 
11 beginning with calendar year 2000, along with any other mailing
 
12 to members, but in no case later than July 1, 2000."
 
13      SECTION 6.  Section 321-15.1, Hawaii Revised Statutes, is
 
14 amended by adding the definition of "hospice home" to be
 
15 appropriately inserted and to read as follows:
 
16      ""Hospice home" means any facility operated by a licensed
 
17 hospice service agency providing twenty-four-hour living
 
18 accommodations to no more than five unrelated persons who are
 
19 admitted for hospice service."
 
20      SECTION 7.  Section 321-15.7, Hawaii Revised Statutes, is
 
21 amended to read as follows:
 
22      "�321-15.7  Penalty.  Any person who intentionally operates
 
23 an adult residential care home or hospice home without a license
 
24 shall be guilty of a misdemeanor."
 

 
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                                     H.B. NO.           H.D. 1
                                                        S.D. 2
                                                        C.D. 1
                                                        

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