The Centers for Medicare and Medicaid Services (CMS) issued a Change Request (CR 13523) on February 22 to clarify how dually eligible Veteran’s Affairs (VA) and Medicare beneficiaries can utilize VA benefits. Although Chapter 9 of the Medicare Benefit Policy Manual states that upon electing the Medicare hospice benefit, the beneficiary waives the right to Medicare payment for any Medicare services related to the terminal illness and related conditions during a hospice election, this does not prevent Veteran’s eligible beneficiaries from receiving services not included on the hospice plan of care, and which are furnished and paid under the beneficiary’s VA benefits, in addition to Medicare hospice services. This may include care and support services that are unique to VA benefits and not typically provided by Medicare hospice agencies, for example, but not limited to, VA home-based primary care for illnesses other than terminal illness.

Any services that are included in the hospice plan of care must be provided and paid for under Medicare. Chapter 9 of the Medicare Benefit Policy manual will be updated to add the following language to Section 60 – Provision of Hospice Services to Medicare/Veteran’s Eligible Beneficiaries:

Upon electing the Medicare hospice benefit, the beneficiary waives the right to Medicare payment for any Medicare services related to the terminal illness and related conditions during a hospice election. However, this does not preclude Veteran’s eligible beneficiaries from receiving services not included on the hospice plan of care, and which are furnished and paid under the beneficiary’s VA benefits, in addition to Medicare hospice services. This may include care and support services that are unique to VA benefits and not typically provided by Medicare hospice agencies, for example, but not limited to, VA home-based primary care for illnesses other than the terminal illness. Any services that are included on the hospice plan of care must be provided and paid under Medicare.