Hospice Volunteers for Non Hospice Patients
In OIG Advisory Opinion No. 12-17, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services considered the question of whether Medicare-certified hospices may provide non-skilled services by volunteers to terminally ill patients. Specifically, the OIG addresses the question of whether such volunteer services may be provided to patients who have a life expectancy of one (1) or year or less, if their illnesses run the normal course, but who do not qualify for hospice services either because they are projected to have more than six (6) months to live or because patients do not wish to renounce curative treatment.
The volunteer services by the Hospice that requested the Advisory Opinion are available only to patients who live in their homes, as defined under the Medicare Home Health benefit, and would not be available to patients who reside in skilled nursing facilities. The non-skilled services include, but are not necessarily limited to: companionship, visitation, transportation in volunteers’ personal automobiles, running errands, food preparation, respite for caregivers, and assistance with reading and writing. The volunteers are unpaid and do not receive any compensation or other remuneration from the Hospice or the Hospital that owns the Hospice.
The Hospice that requested the Opinion employs a volunteer coordinator to oversee the volunteers and communicate with patients receiving volunteer services to ensure that the resources and needs of patients are identified. The expenses of the volunteer services, including the volunteer coordinator’s salary, are paid separately from the Hospice’s and the Hospital’s expenses and are not be included on their respective cost reports. The Hospital’s foundation will help the hospice raise funds for the volunteer services for the first year during which they are provided. Thereafter, the Hospital may fund the services if it decides that the services fulfill an unmet need in the community.
The Hospice expects to receive referrals for volunteer services from three primary sources: (1) the Hospital and other hospitals in the area, (2) physicians’ offices, and (3) patients’ family members. The Hospice does not actively market the availability of the services to the community, but educates discharge planners/case managers at local hospitals about the purpose of the services, including an explanation about the eligibility criteria described above. The Hospice also explains the services to physicians’ offices and family members, but only if the Hospice is contacted and asked to do so. Patients who decide to receive the volunteer services are given a letter from the Hospice explaining the right of patients to choose home health or hospice providers, and a list of agencies and hospices in the area where patients reside.
The OIG concluded that the volunteer services have, at a minimum, intangible, psychological value to patients. Patients may also be relieved of financial expenditures that they might have incurred to engage others to provide such services. The services may also influence patients to select the Hospice as their provider of hospice services in the future.
Despite these concerns, the OIG concluded that the Hospice is not subject to sanctions under the federal anti-kickback statute for the following reasons:
1. The Hospice does not market the volunteer services in the community, other than explaining the purpose of the program and its eligibility criteria to local hospital case managers and to others upon request.
2. The Hospice provides patients who receive volunteer services with information about all known home health and hospice providers in patients’ geographic area, so that they can exercise their freedom of choice.
3. Patients’ decision to elect hospice care when they qualify is likely to be based on patients’ choice to reject curative treatment, not on the availability of volunteer services.
The OIG went on to caution hospices that they may not offer patients inducements to choose hospices. The Advisory Opinion, according to the OIG, means only that involve a relatively small monetary value provided by unpaid volunteers, the requirement that hospice patients forego curative care for their underlying terminal illnesses provides a safeguard against the overutilization often associated with such inducements.
Hospices that wish to provide volunteer services, such as those described above, must be meticulous about meeting all of the criteria spelled out in the OIG’s Advisory Opinion. Hospices that fail to do so may be subject to enforcement action.
Elizabeth E. Hogue, Esq.
©2020 Elizabeth E. Hogue, Esq. All rights reserved.