State programs allowing concurrent hospice and curative care can provide much needed relief for patients and families. However, the programs can be difficult to navigate for providers who must determine which treatments should be covered by the hospice and which should be billed as concurrent care.
Among U.S. states, 32 offer models for pediatric concurrent care — including services such as dialysis, chemotherapy, and medication, among others — in accordance with section 2302 of the Affordable Care Act, according to a study published this month in Health Affairs. The specifics of these models vary from state to state. Generally, these programs apply to patients 21-years-old or younger.
“Advocates of pediatric hospice care recognized that the strict choice between curative and hospice care was a significant barrier to enrollment in pediatric hospice services at the end of life,” the study authors wrote. “To overcome this barrier, in the 2000s several states demonstrated innovation in financing and care models and developed alternative pathways to enrollment in pediatric hospice that allowed children to continue to receive curative care.”
Annually, more than 55,000 pediatric patients die from a chronic or medically complex condition. A large proportion of these children are Medicaid enrollees, the study indicated.
While data on pediatric utilization is limited, the study reported that only a small number receive hospice care. This could change, however, as more hospices nationwide sharpen their focus on pediatrics.
“[Concurrent care] was a very huge catalyst for growth in some pediatric hospice services across the country,” said Diane Parker, vice president of operations for Traditions Health, in a session at the National Hospice & Palliative Care Association’s Interdisciplinary Conference. “No longer did parents or a child that can make their decisions have to give up hope or aggressive care, but they could still elect the hospice benefit. So it does bring hope.”
Determining which treatments and services fall under the hospice benefit and which do not is a complex process for any hospice patient, pediatric or adult. The opportunity for concurrent care can further complicate these decisions.
Conversations with suppliers and vendors about concurrent care coverage is key to compliance, including providers of pharmacy services and durable medical equipment. According to Parker, this education is crucial to effective care coordination for pediatric patients.
Establishing a strong relationship and consistent communication with state agencies that oversee these programs is essential to ensuring regulatory compliance and accurate billing.
“Don’t assume that it’s a seamless process, because you will be massively confused,” Parker said. “In our organization, we serve three states, and it is a different conversation in every state about what to cover what not to cover. We just can’t give up on that. So we have to continue to navigate through the confusion, and if we can develop a best practice, establish that great contact in that office, then it’s easier to navigate and then our team learns from that as well.”