OIG issues report on election statements, terminal illness certifications

115

The Inspector General of the Department of Health and Human Services (OIG) has released a report calling on hospices to improve their election statements and certifications of terminal illness.

The report summary links to the full report. The National Hospice and Palliative Care Organization recently issued a regulatory alert on this issue.

The OIG report uses data from a stratified random sample of 565 hospice general inpatient (GIP) stays in 2012. The findings identify vulnerabilities in hospice election statements and include:

  • Election statements missing required elements: 35 percent of GIP stays in the sample used election statements that were missing required information or had other vulnerabilities.
  • Waiver of certain Medicare services: Some election statements did not mention that the beneficiary was waiving coverage of certain Medicare services, others inaccurately stated what Medicare services are waived.
  • Palliative rather than curative: Some election statements did not state that hospice care was palliative rather than curative. The OIG reiterated that election statements, as indicated in the Medicare Benefit Policy Manual, state that the beneficiary or their representative must have a full understanding of this type of care.

The OIG also noted that in 4 percent of the stays, the election statement included “inaccurate or unclear information about revocation or discharge.” This information is not currently required in the election statement.

The OIG made the following recommendations to CMS:

  • Develop and disseminate model text for election statements
  • Instruct surveyors to strengthen their review of election statements and certifications of terminal illness
  • Educate hospices about election statements and certifications of terminal illness
  • Provide guidance to hospices regarding the effects on beneficiaries when they revoke their election and when they are discharged from hospice care