by Jim Nintzel
State legislators, in an attempt to balance the budget, have cut care options for some terminally ill Arizonans, and hospices may have to repay the state for services already provided.
A footnote in the Legislature's 2007 General Appropriation Act allowed the Arizona Health Care Cost Containment System to match federal funds for hospice services needed by acute-care patients. It was a one-year appropriation that was renewed in 2008, but not for the fiscal year that began on July 1, 2009. Even though legislators approved the budget in July, AHCCCS continued authorizing hospice payments for another six months.
Last month, AHCCCS sent a letter to providers telling them that the funding had been eliminated, and it suggested they would have to repay the state.
Reporter Kimberly Matas notes that the decision will ultimately cost the state more money as sick people end up in the hospital instead:
AHCCCS members enrolled in the agency's long-term-care program retain their hospice benefits, but other patients likely will end up in hospital emergency rooms without the hospice benefit. The average hospice stay is 20 days, according to the National Hospice and Palliative Care Organization.
"Typically in the hospice world, individuals are not seeking aggressive treatment anymore; they are seeking comfort care," said Agnes Poore, chief clinical officer and co-founder of Casa de la Luz Hospice. "But typically in the hospital, they might do diagnostic tests. If you need pain management, they might admit you to the hospital. Emergency room and hospital costs are enormous compared to what you would pay for hospice care."
Last year, 541 acute-care hospice patients were enrolled in AHCCCS. Those same patients would not be eligible for AHCCCS-funded hospice benefits today.
Hospice providers in Tucson estimate the average cost for a day of hospice care - which includes medication, equipment, staffing, and spiritual and social support in a patient's home - is $140. The alternative now for low-income patients who lost their AHCCCS hospice benefits is hospitalization, which can cost up to 10 times more.