First, what happened was restrictions on hospice patients' Medicare Part D prescriptions were decreased, not increased.
Second, Medicare Part A (hospitalization) is what pays for hospice services.
What does Medicare Part A cover?
Medicare does not pay for long-term care. The only nursing home care Medicare pays for is rehabilitative care. This article has little to do with nursing homes. There is no way someone would be in a Medicare paid for nursing home while on Medicare paid for hospice. However, someone could be in a self-paid or Medicaid paid long-term care facility and require hospice care.
Hospice providers are not the same thing as nursing homes. Someone in a long-term care who is a hospice patient gets their hospice services from a hospice provider. Hospice providers are regulated differently from hospitals and long-term care faciliites That hospice provider may be a subsidiary of the long-term care facility, or it may be separate.
When you are in the hospital, Medicare Part A (not Part D) pays for any prescription drug you get while in the hospital. With hospice, it works the same (both for outpatient hospice and inpatient hospice). The hospice provider bills Medicare for hospice services, which included palliative drugs. Like hospitals, most hospice providers have their own pharmacies which provide these drugs.
Given the level of narcotics used by hospice, I don't think you could even get those from your local CVS using Medicare Part D.
Hospice is end of life care. Once you go into hospice, you are stopping treatment of underlying diseases. Once one chooses for Medicare to pay for their hospice services, Medicare stops paying for curative services.
What appears to have been happening here is some hospice providers were billing Part D for hospice drugs (defined by Medicare). By law, Part D cannot pay for drugs which are paid for by Part A or Part B.
Medicare does limit hospice reimbursement to a certain daily amount, and all palliative drugs come out of that payment. But that is way hospice works under Medicare.
Second, if you are in hospice, you have little need for drugs you would get via Part D, because curative care is discontinued in hospice. Medications for chronic conditions (blood pressure, cholesterol, diabetes) generally stop, unless stopping those drugs would cause pain or discomfort. So something tells me these are corner cases.
The parenthetical comment, Medicare "won't pay for pain relief pills" is completely wrong. Pain medications are palliative and are covered by Part A for hospice patients.
As I said, need to read the articles.
You say:
“First, what happened was restrictions on hospice patients’ Medicare Part D prescriptions were decreased, not increased. “
Yes, AFTER the restrictions were INCREASED.
See my post 12:
“Instead of leaving it to insurers and hospice providers to identify the drugs they are responsible for, the new rule sets up a process that requires Part D plans to reject initially any prescription from a hospice patient. The patient or doctor, with the hospice provider’s agreement, must explain to the insurer why the drug is not related to end-of-life care. The insurer may deny coverage for a number of reasons, including if the doctor or hospice did not explain sufficiently why the drug was unrelated to the terminal illness, Medicare officials told hospice organizations and insurers”
Medicare Seeks To Stop Overpayments For Hospice Patients’ Drugs
May 1, 2014