Hospice and Health Care Reform: Improving Care at the End of Life

Health care reform focused on coverage of hospice care in significant ways. Specifically, the Patient Protection and Affordable Care Act (the Act) recognized the value in accessing hospice services as soon as possible by (1) immediately authorizing concurrent payment for curative and palliative care to children with Medicaid coverage and (2) authorizing a demonstration program to study the value of doing so with respect to Medicare beneficiaries. It also, however, imposed an additional requirement on physicians and nurse practitioners recertifying patients for hospice care eligibility, thus potentially over-regulating one aspect of hospice care. This Article lauds Congress for its position with respect to concurrent care but cautions that legal, regulatory, and medical professionals should carefully monitor the effects of the change Congress made to the recertification requirements. Without careful monitoring and calibration, the latter change could inappropriately chill hospice recertifications, thus negating part of the good accomplished through the former change.