Eligibility & Reimbursement
Reimbursement for Services
Medicare, Arizona Long-Term Care System (ALTCS), most AHCCCS plans and nearly all private insurance plans have a hospice benefit that covers costs associated with hospice care.
Beneficiaries who elect the Medicare hospice benefit agree to forego curative treatment for their terminal condition. For conditions unrelated to their terminal diagnosis, Medicare and other payors continue to cover items and services outside of hospice. For example, a hospice patient who is injured in a fall could go to his personal physician for treatment, and the physician would be reimbursed for care.
Hospice Eligibility Guidelines
The first step in evaluating whether a patient with a life-limiting illness is appropriate for hospice care is determining that the patient prefers hospice and palliative care over curative treatment. In addition, a patient will likely have one or more of the following indicators present:
- Loss of function/physical decline
- Increase in hospitalizations
- Dependence in most activities of daily living
- Multiple co-morbidities
- Increase in ER visits
- Weight loss