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Veterans: Hospice Inpatient Care Policy
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Related FAQs:

QUESTION: Under what circumstances should the VA pay for both contract nursing home care and hospice services under the VA hospice benefit?

ANSWER:

When a veteran is placed by VA in a community nursing for the purpose of hospice care, the cost of care, including the nursing home portion of that care is covered by the VA hospice benefit.

No, if the veteran is in a community nursing home at the time of referral for hospice care, the VA’s hospice benefit does not cover the nursing home component of care. The veteran remains responsible for the cost of the nursing home care. 757 722 9961 x3456 or 757 879 9843 OR Catherine Kelso MD at Catherine.Kelso@va.gov or call (804) 675-5552 with any further questions.

 

QUESTION: If an enrolled veteran, in a community nursing home not at VA expense, develops a need for hospice care, is the VA required to pay for the nursing home care also?

ANSWER:

The veteran may request hospice care through the VA, or may obtain needed hospice services through Medicare, Medicaid or private insurance if eligible. If VA is requested to provide hospice care, VA can purchase the care as hospice consultation or as bundled services from a home hospice program.

1) The VA may pay a $60.00 per diem rate to the hospice for hospice consultation services, which would consist of professional services, such as visiting nurse and social worker, educational assistance to the nursing home staff in the provision of care, patient/family support in coping with the dying process and ongoing determination of the patient’s goals of care. Or

2) The VA may pay the full home hospice care rate to the hospice for the usual comprehensive services - hospice diagnosis-related home visits by professional and paraprofessional staff, medications, supplies, biologicals, durable medical equipment and ancillary services, as outlined in the plan of care. Community hospice care also covers bereavement care for the family as part of the hospice care plan, without additional reimbursement.

Please contact Jorge Cortina MD at Jorge.Cortina@va.gov

 

Hospice and Inpatient Care Policy Summary

Hospice and palliative care is a covered benefit for all enrolled veterans, on par with all other medical services included in the Medical Benefits Package. VA offers to provide or purchase needed hospice and palliative care services for all enrolled veterans, whether these are needed in an inpatient setting or in the home. VA ensures that all enrolled veterans in need of hospice care are able to obtain these needed services (VHA Handbook 1140.5 (3.5.a.). When a veteran is placed by VA in a contract Community Nursing Home for the purpose of hospice care, the cost of that care, including the nursing home portion of that care is covered by the VA hospice benefit (VHA Handbook 1140.5 (8.g.(2)(a)2.(b)).

VHA Hospice Care is care provided to a veteran meeting all of the following criteria: (1) is diagnosed with a life limiting illness. (2) has treatment goals focused on comfort rather than cure. (3) has a life expectancy, deemed by a VA physician, to be 6 months or less if the disease runs its normal course and (4) accepts hospice care (VHA Handbook 1140.5 (3.b.).

The VA health care professional identifies and discusses with the veteran the options for care setting, certified agencies, and payer. Home hospice care is provided in the patient’s place of residence, which may be a home, a nursing home or other community-based residential setting. Inpatient hospice care may be provided in a VA facility (the preferred site), in a contract Community Nursing Home that has an established relationship with a hospice agency or in an inpatient hospice setting through a community provider (VHA Handbook 1140.5 (7c,8.f.(1),8g(1)(2)(3)).

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