HOUSE OF REPRESENTATIVES             H.C.R. NO.12          
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                     HOUSE CONCURRENT
                        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

 
 
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 1       WHEREAS, a hospice program is reimbursed $107 per day by
 2   Medicare, whether the patient is at home or in a residential
 3   facility, while Hawaii Medicaid reimburses hospice care at a
 4   rate of only $103 per day in contrast to an acute care hospital
 5   rate of $458 per day; and
 6   
 7       WHEREAS, the average cost of residential hospice care in
 8   Hawaii is $160-$210 per day, over and above the base cost of
 9   $150 per day for at-home hospice care; and
10   
11       WHEREAS, hospice programs have emphasized and are often
12   required at-home care, and currently, Medicare requires more
13   than eighty percent of the days in each hospice to be spent in
14   at-home care, however, many patients in need of or who could
15   benefit from hospice services have no family members or other
16   unpaid, supportive persons who could be available around-the-
17   clock; and
18   
19       WHEREAS, improvements in the care of dying patients must
20   take place in settings other than at-home care, as most
21   Americans die in either hospitals (sixty-one percent) or
22   nursing homes (seventeen percent); and
23   
24       WHEREAS, the Governor's Blue Ribbon Panel on Living and
25   Dying with Dignity unanimously recommended, among other things,
26   that hospice care be made more available and offered more
27   expediently to the dying; now, therefore,
28   
29       BE IT RESOLVED by the House of Representatives of the
30   Twentieth Legislature of the State of Hawaii, Regular Session
31   of 1999, the Senate concurring, that the Department of Human
32   Services, Med-QUEST Division, health care providers, and health
33   insurers are urged to make hospice care available and
34   expediently to the dying; and
35   
36       BE IT FURTHER RESOLVED that the Department of Human
37   Services expand Hawaii's Medicaid benefits for hospice care for
38   anyone with a life expectancy of one year or less; and
39   
40       BE IT FURTHER RESOLVED that professional health care
41   associations develop standards or adopt existing standards
42   pertaining to full disclosure of all health care options,
43   including hospice care; and

 
 
 
 
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                                  H.C.R. NO.12          
                                                        
                                                        

 
 1       BE IT FURTHER RESOLVED that such standards be:
 2   
 3       (1)  Established and reviewed by the appropriate
 4            professional boards;
 5   
 6       (2)  Incorporated into peer review mechanisms; and
 7   
 8       (3)  Shared with referring agencies;
 9   
10       and
11   
12       BE IT FURTHER RESOLVED that Hawaii health insurance plans
13   include:
14   
15       (1)  Coverage for hospice care, with the Medicare per diem
16            rate established as the minimum rate; and
17   
18       (2)  Reimbursement for the "room and board" portion of
19            hospice facilities;
20   
21       and
22   
23       BE IT FURTHER RESOLVED that the "mutually exclusive"
24   eligibility requirement for hospice and non-hospice care be
25   eliminated; and
26   
27       BE IT FURTHER RESOLVED that health insurers recognize
28   hospice referral visits as a reimbursable benefit, whether or
29   not the referred patients are admitted to hospice; and
30   
31       BE IT FURTHER RESOLVED that long-term and extended care
32   facilities be required to have a contractual relationship with
33   a hospice service provider to allow access to these services,
34   if needed; and
35   
36       BE IT FURTHER RESOLVED that health care plans subscribing
37   to national quality assurance standards include quality of care
38   at the end of life in such areas as symptoms, function, advance
39   planning, aggressive life-extending treatments, patient
40   satisfaction, family satisfaction, quality of life, family
41   burden, survival time, provider continuity and skill, and
42   bereavement; and

 
 
 
 
 
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                                  H.C.R. NO.12          
                                                        
                                                        

 
 1       BE IT FURTHER RESOLVED that certified copies of this
 2   Concurrent Resolution be transmitted to the Department of Human
 3   Services, the Hawaii Medical Association, the Hawaii Nurses
 4   Association, the Hawaii Medical Services Association, the
 5   Queen's Health Plan, Kaiser Permanente, and the Healthcare
 6   Association of Hawaii.
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