Controlled Substances – Hospice Fix: Allow physicians...
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Controlled Substances Glitch Bill with a Hospice Fix When the 2018 Legislature passed the Controlled Substances (HB21) Bill, it was believed that late amendments exempted hospice and palliative care out the onerous requirements for prescribing opioids. In reality, the exemption applied only to the “days of supply” restrictions. Physicians prescribing opioids to hospice and palliative care patients must now consult the Prescription Drug Monitoring Program database (PDMP) for every prescription, and every change in prescription. This is extremely burdensome and serves no purpose in combating the abuse of opioids. With more than 137,000 hospice admissions last year, and an estimated average of 20 changes in prescriptions per hospice patient between hospice election and discharge/death, this requirement has created a burden that can affect the timely delivery of patient care, and does not contribute useful data to the system. Often, as many as half of the prescription changes occur within the first 48 hours after hospice election, at all hours of the day or night, as physicians aggressively pursue symptom control to stabilize the patient. We ask for hospice to be exempted entirely, or to only be required to check the PDMP database once upon the patient electing hospice. Controlled Substances – Hospice Fix: Allow physicians prescribing to hospice and palliative care patients to be exempted from PDMP database check requirements, or only require it to be checked on the initial prescription for these patients. Statewide Medicaid Managed Care Resolve Continuing Concerns Hospice renders services for Statewide Medicaid Managed Care (SMMC) patients and since 2014 have experienced increasing difficulty being reimbursed, with mounting aging accounts and significant burdens to hospice staff. Medicaid only amounts to about 6% of hospice revenue, but most hospice providers have as many or more staff dedicated to collecting Medicaid, as they do for collecting Medicare, which is 87.2% of their revenue. FHPCA has worked tirelessly with all parties to help bridge the gap, but aging accounts continue to grow into tens of millions of dollars. Additional pressures need to be put on SMMC plans to incentivize them to solve systemic payer dysfunction, pay aging accounts, and to assure quality patient care is protected. SMMC: Ask hard questions of the Plans, compel Plans to timely pay hospice providers for services rendered, compel plans to pay outstanding aging accounts, compel plans to stop end bureaucratic burdens that do not enhance patient care, stop plans from meddling in end-of-life care services they know little about.
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ControlledSubstancesGlitchBillwithaHospiceFix When the 2018 Legislature passed the ControlledSubstances (HB21) Bill, it was believed that lateamendmentsexemptedhospiceandpalliativecareouttheonerous requirements for prescribing opioids. In reality,the exemption applied only to the “days of supply”restrictions. Physiciansprescribingopioids tohospiceandpalliative carepatientsmust now consult thePrescriptionDrug Monitoring Program database (PDMP) for everyprescription, and every change in prescription. This is
extremelyburdensomeandservesnopurposeincombatingtheabuseofopioids. Withmore than137,000hospice admissions last year, and anestimated average of 20 changes in prescriptions per hospice patientbetween hospice election and discharge/death, this requirement hascreatedaburdenthatcanaffectthetimelydeliveryofpatientcare,anddoesnotcontributeusefuldatatothesystem.Often,asmanyashalfofthe prescription changes occur within the first 48 hours after hospiceelection,atallhoursofthedayornight,asphysiciansaggressivelypursuesymptom control to stabilize the patient. We ask for hospice to beexemptedentirely,or toonlybe required to check thePDMPdatabaseonceuponthepatientelectinghospice.
Controlled Substances – Hospice Fix:Allow physicians prescribing to hospice and palliative care patients to beexemptedfromPDMPdatabasecheckrequirements,oronlyrequireittobecheckedontheinitialprescriptionforthesepatients.StatewideMedicaidManagedCareResolveContinuingConcernsHospicerendersservicesforStatewideMedicaidManagedCare(SMMC)patientsandsince2014haveexperiencedincreasingdifficultybeingreimbursed,withmountingagingaccountsandsignificantburdenstohospicestaff.Medicaidonlyamountstoabout6%ofhospicerevenue,butmosthospiceprovidershaveasmanyormorestaffdedicatedtocollectingMedicaid,astheydoforcollectingMedicare,whichis87.2%oftheirrevenue.
FHPCAhasworkedtirelesslywithallpartiestohelpbridgethegap,butagingaccountscontinuetogrowintotensofmillionsofdollars.AdditionalpressuresneedtobeputonSMMCplans to incentivize themtosolvesystemicpayerdysfunction,payagingaccounts,andtoassurequalitypatientcareisprotected.
SMMC:AskhardquestionsofthePlans,compelPlanstotimelypayhospiceprovidersforservicesrendered,compelplanstopayoutstandingagingaccounts,compelplanstostopendbureaucraticburdensthatdonotenhancepatientcare,stopplansfrommeddlinginend-of-lifecareservicestheyknowlittleabout.
