Good news on managed care contracts
A recent letter from Janice M. Caldwell, associate regional administrator in HCFA's San Francisco Region IX office, to Margaret Clausen, CAE, executive director of the California State Hospice Association in Sacramento, clarifies one thorny issue that had emerged from the work of the Arlington, VA-based National Hospice Organization's Operation Restore Trust Task Force.
The issue questioned is whether certified hospices can contract with other payers for non-Medicare patients without having to pay directly for required ancillary services such as medications and supplies. Managed care organizations often have their own national contracts for these services and aren't willing to use the hospice as a pass-through.
"When a hospice provides services under arrangements to non-Medicare beneficiaries, the hospice is responsible for establishing how payment for those services will occur, but the standard does not require the hospice to pay for those services directly or to pay for services for which there is no reimbursement or for services for which another insurer is obligated to pay," Caldwell says. Since this letter is based on clarification provided by HCFA Central, it would seem to offer some needed flexibility for certified hospices trying to pursue relationships with other payers.
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