HPM FAST HOSPICE QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS.
Question 1
A 65-year-old man with stage IV pancreatic cancer dies while on hospice
services. His daughter moved in with him during his illness to provide around-
the-clock care for him. She lives in California and took a leave of absence from
her job to stay with him in Nevada. After his funeral, she sold his home and
managed the other aspects of his estate. The hospice agency contacted her 2
weeks after her father's death for a routine bereavement call. She expressed
sadness and was using friends and extended family for support. She mentioned
she was planning to move back to California within the next 2 weeks.
Which of the following options most accurately describes the responsibility of
the hospice bereavement program?
a. No further interaction is needed because she is coping well and moving out
of the hospice agency's service area.
b. The hospice agency should obtain accurate contact information and transfer
Answer - The correct answer is option C, the hospice agency should document
the change in plan of care and arrange for future contact at her new address.
The Code of Federal Regulations (CFR) 418.64 under Bereavement Counseling
states hospices must:
• "Have an organized program for the provision of bereavement services
furnished under the supervision of a qualified professional with experience or
education in grief or loss counseling.
,• Make bereavement services available to the family and other individuals in
the bereavement plan of care up to 1 year following the death of the patient.
Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when
appropriate and identified in the bereavement plan of care
• Ensure that bereavement services reflect the needs of the bereaved.
• Develop a bereavement plan of care that notes the kind of bereavement
services to be offered and the frequency of service delivery."
Option A, no further interaction is needed because she is coping well and
moving out of the hospice agency's service area, and option D, no further
interaction is needed if the plan of care and contact information are updated
and an offer of support is provided by the hospice agency, are incorrect
because it is federally mandated that bereavement care be offered for up to 1
year following a patient's death. Option B, the hospice agency should obtain
accurate contact information and transfer bereavement care to a hospice
agency in her town, is incorrect because bereavement care cannot be
transferred to another hospice agency. However, the hospice agency can help
bereaved family members identify grief and bereavement resources in their
new community.
Take Home Point
Bereavement care must be provided to a patient's caregiver or loved one in
accordance with usual care, even if the caregiver or loved one moves
Question 2
An 87-year-old man is admitted to hospice care with a diagnosis of Alzheimer's
disease. He was initially admitted to hospice following a hospitalization for
urosepsis, during which he developed delirium. He is midway through his
second benefit period under the Medicare hospice benefit. He has a Palliative
Performance Scale score of 50% and Functional Assessment Staging of
Alzheimer's Disease (FAST) score of 6c improved from an initial FAST score of
7c. He is able to eat slowly. He has mild knee pain but otherwise his symptoms
,are managed. He has not had any infections or new wounds since his last
certification period. His weight is down to 118 pounds from 120 pounds. His
wife is his primary caregiver and has difficulty caring for him alone.
Which of the following actions is the next best step?
a. Schedule a face-to-face visit 30 days before the end of benefit period with
plans to recertify the patient Answer - The correct answer is option C, call a
family conference to discuss placement in a structured living facility and
disenroll the patient from hospice care.
The hospice must have a discharge planning process in place that takes into
account the possibility that a patient's condition might stabilize or otherwise
change in such a way that the patient cannot continue to be certified as
terminally ill. To ensure a safe transition plan is created, the discharge planning
process must include planning for any necessary family counseling, patient
education, or other services before the patient is discharged because he or she
no longer qualifies for the Medicare hospice benefit.
Once a patient is no longer considered to have a life expectancy of 6 months or
less if the disease runs its normal course, Medicare coverage and payment for
hospice care should cease. Medicare does not expect that a discharge would
happen immediately and allows time for post-discharge planning. It would be
expected that the hospice's interdisciplinary group is following the patient and
if there are indications of improvement in the individual's condition such that
hospice may soon no longer be appropriate, then discharge planning should
begin. If the patient seems to be stabilizing and the disease progression has
halted, it is important to begin preparing the patient for alternative care.
Discharge planning should be a process, and planning should begin before the
date of discharge.
Option A, schedule a face-to-face visit 30 days before the end of the benefit
period with plans to recertify the patient for hospice care is incorrect. There is
, no evidence that the patient continues to meet criteria for hospice eligibility
for Alzheimer's disease. Option B, deliver the Notice of Medicare Non-Coverage
2 days prior to end of benefit period and disenroll the
Question 3
A 68-year-old man with metastatic non-small cell lung cancer is referred for
hospice services. He was diagnosed 2 years ago and initially treated with
radiation therapy to the lung. He now has new metastases to the brain and
liver and does not want further cancer therapy. He has comorbid end-stage
renal disease (ESRD) secondary to diabetic nephropathy and has been on
hemodialysis (HD) for the past 4 years. His appetite and oral intake are poor. He
has increasing fatigue and currently spends more than 50% of his time in bed
or in a recliner chair. He is agreeable to receiving hospice services but does not
want to stop dialysis.
Which of the following is true regarding Medicare coverage for dialysis for this
patient?
a. The patient may continue dialysis because his terminal diagnosis is not
related to his ESRD diagnosis.
b. The patient may continue dialysis, but the hospice agency must cover the
dialys Answer - The correct answer is option A, the patient may continue
dialysis because his terminal diagnosis is not related to his ESRD diagnosis.
Medicare patients may receive care under both the ESRD benefit and the
hospice benefit as long as (a) the patient's terminal condition is not related to
the ESRD and (b) in the physician's opinion, continuing dialysis treatment will
not extend the patient's prognosis past 6 months.
Option B, the patient may continue dialysis, but the hospice agency must cover
the dialysis-associated costs, is incorrect. The terminal diagnosis is unrelated to
ESRD, so the costs for hemodialysis can continue to be paid by Medicare
outside of the Medicare hospice benefit. A hospice agency must cover the cost
of dialysis if ESRD is related to the terminal diagnosis. Option C, the patient
COMPLETE SOLUTIONS.
Question 1
A 65-year-old man with stage IV pancreatic cancer dies while on hospice
services. His daughter moved in with him during his illness to provide around-
the-clock care for him. She lives in California and took a leave of absence from
her job to stay with him in Nevada. After his funeral, she sold his home and
managed the other aspects of his estate. The hospice agency contacted her 2
weeks after her father's death for a routine bereavement call. She expressed
sadness and was using friends and extended family for support. She mentioned
she was planning to move back to California within the next 2 weeks.
Which of the following options most accurately describes the responsibility of
the hospice bereavement program?
a. No further interaction is needed because she is coping well and moving out
of the hospice agency's service area.
b. The hospice agency should obtain accurate contact information and transfer
Answer - The correct answer is option C, the hospice agency should document
the change in plan of care and arrange for future contact at her new address.
The Code of Federal Regulations (CFR) 418.64 under Bereavement Counseling
states hospices must:
• "Have an organized program for the provision of bereavement services
furnished under the supervision of a qualified professional with experience or
education in grief or loss counseling.
,• Make bereavement services available to the family and other individuals in
the bereavement plan of care up to 1 year following the death of the patient.
Bereavement counseling also extends to residents of a SNF/NF or ICF/IID when
appropriate and identified in the bereavement plan of care
• Ensure that bereavement services reflect the needs of the bereaved.
• Develop a bereavement plan of care that notes the kind of bereavement
services to be offered and the frequency of service delivery."
Option A, no further interaction is needed because she is coping well and
moving out of the hospice agency's service area, and option D, no further
interaction is needed if the plan of care and contact information are updated
and an offer of support is provided by the hospice agency, are incorrect
because it is federally mandated that bereavement care be offered for up to 1
year following a patient's death. Option B, the hospice agency should obtain
accurate contact information and transfer bereavement care to a hospice
agency in her town, is incorrect because bereavement care cannot be
transferred to another hospice agency. However, the hospice agency can help
bereaved family members identify grief and bereavement resources in their
new community.
Take Home Point
Bereavement care must be provided to a patient's caregiver or loved one in
accordance with usual care, even if the caregiver or loved one moves
Question 2
An 87-year-old man is admitted to hospice care with a diagnosis of Alzheimer's
disease. He was initially admitted to hospice following a hospitalization for
urosepsis, during which he developed delirium. He is midway through his
second benefit period under the Medicare hospice benefit. He has a Palliative
Performance Scale score of 50% and Functional Assessment Staging of
Alzheimer's Disease (FAST) score of 6c improved from an initial FAST score of
7c. He is able to eat slowly. He has mild knee pain but otherwise his symptoms
,are managed. He has not had any infections or new wounds since his last
certification period. His weight is down to 118 pounds from 120 pounds. His
wife is his primary caregiver and has difficulty caring for him alone.
Which of the following actions is the next best step?
a. Schedule a face-to-face visit 30 days before the end of benefit period with
plans to recertify the patient Answer - The correct answer is option C, call a
family conference to discuss placement in a structured living facility and
disenroll the patient from hospice care.
The hospice must have a discharge planning process in place that takes into
account the possibility that a patient's condition might stabilize or otherwise
change in such a way that the patient cannot continue to be certified as
terminally ill. To ensure a safe transition plan is created, the discharge planning
process must include planning for any necessary family counseling, patient
education, or other services before the patient is discharged because he or she
no longer qualifies for the Medicare hospice benefit.
Once a patient is no longer considered to have a life expectancy of 6 months or
less if the disease runs its normal course, Medicare coverage and payment for
hospice care should cease. Medicare does not expect that a discharge would
happen immediately and allows time for post-discharge planning. It would be
expected that the hospice's interdisciplinary group is following the patient and
if there are indications of improvement in the individual's condition such that
hospice may soon no longer be appropriate, then discharge planning should
begin. If the patient seems to be stabilizing and the disease progression has
halted, it is important to begin preparing the patient for alternative care.
Discharge planning should be a process, and planning should begin before the
date of discharge.
Option A, schedule a face-to-face visit 30 days before the end of the benefit
period with plans to recertify the patient for hospice care is incorrect. There is
, no evidence that the patient continues to meet criteria for hospice eligibility
for Alzheimer's disease. Option B, deliver the Notice of Medicare Non-Coverage
2 days prior to end of benefit period and disenroll the
Question 3
A 68-year-old man with metastatic non-small cell lung cancer is referred for
hospice services. He was diagnosed 2 years ago and initially treated with
radiation therapy to the lung. He now has new metastases to the brain and
liver and does not want further cancer therapy. He has comorbid end-stage
renal disease (ESRD) secondary to diabetic nephropathy and has been on
hemodialysis (HD) for the past 4 years. His appetite and oral intake are poor. He
has increasing fatigue and currently spends more than 50% of his time in bed
or in a recliner chair. He is agreeable to receiving hospice services but does not
want to stop dialysis.
Which of the following is true regarding Medicare coverage for dialysis for this
patient?
a. The patient may continue dialysis because his terminal diagnosis is not
related to his ESRD diagnosis.
b. The patient may continue dialysis, but the hospice agency must cover the
dialys Answer - The correct answer is option A, the patient may continue
dialysis because his terminal diagnosis is not related to his ESRD diagnosis.
Medicare patients may receive care under both the ESRD benefit and the
hospice benefit as long as (a) the patient's terminal condition is not related to
the ESRD and (b) in the physician's opinion, continuing dialysis treatment will
not extend the patient's prognosis past 6 months.
Option B, the patient may continue dialysis, but the hospice agency must cover
the dialysis-associated costs, is incorrect. The terminal diagnosis is unrelated to
ESRD, so the costs for hemodialysis can continue to be paid by Medicare
outside of the Medicare hospice benefit. A hospice agency must cover the cost
of dialysis if ESRD is related to the terminal diagnosis. Option C, the patient
