My hubby has been on hospice for 9 months. I was informed last week that the hospice benefit will terminate on Dec. 4. I was also advised that I could appeal the decision but I'm not planning to do that, I actually agree with them that he isn't really actively dying at this point. But they also advised that there is a lifetime CAP on hospice benefit; however, neither the social worker nor the nurse knew the details. I've looked on the Medicare.gov site and various other websites and everything confirms what I've always I understood--that there are two 90-day periods followed by an UNLIMITED number of 60-day periods, as long as the patient is properly certified. The hospice social worker says if you "use up" the benefit, then you aren't able to get hospice coverage anymore. Anybody know the truth? Thanks!
There is an aggregate cap on hospice organizations to prevent Medicare from paying them more for end of life care than Medicare would be paid if the patient was receiving conventional care, say in a hospital. Thus the cap has to do with the hospice organization, aggregated over ALL of their patients, not any individual patient.
In reading on both the CMS (Centers for Medicare and Medicaid) AARP and Caring.com, they mention that there is a great deal of misinformation circulating about Hospice Caps. In your case, I would call the administrative office of your hospice organization on Monday and tell them about your conversation with their employees. They can set your mind at ease and correct the misinformation being spread.
Happy Thanksgiving!