In The News

Using Palliative Sedation At End of Life

By Barbara Karnes

Palliative sedation is a term used by hospice, palliative care, and medical professionals to describe giving large doses of sleep-inducing medications to induce unconsciousness. It is a pain management technique used when all other pain management options have been unsuccessful. It is not routinely used. I would even say it is seldom used.

The National Cancer Institute defines palliative sedation as: “The use of special drugs called sedatives to relieve extreme suffering by making a patient calm, unaware, or unconscious. This may be done for patients who have symptoms that cannot be controlled with other treatments. Palliative sedation may be used in patients who are near the end of life to make them more comfortable. It is not meant to shorten life or cause death.” 

I found many other definitions (I love the internet), but this one was the easiest to understand and said what the others were saying but in much less technical detail.

When the terminal illness, the disease progression, has been a pain-filled experience and all comfort management options have been unsuccessful, then sleep is our friend. Sleep, created by regulated, supervised medications, is a compassionate alternative to uncontrollable suffering. 

Covid taught us the benefit of “putting a person to sleep” as their body heals. That same technique can also be used as end of life approaches. Not to accelerate the end of life process, but to provide comfort until death comes.


Prisma Uses VR Tech to Bring Outdoors to Hospice Patients | By Andrea Kelley

SENECA — Years ago, Lisa Dwiggins headed out West to visit her father, Bobby Finch. They hopped on his motorcycle — a Harley Davidson — and wound through the canyons, taking in the view.

Thanks to a new virtual reality program at Prisma Health Hospice of the Foothills, Dwiggins and Finch were able to visit those places again — together. The duo first heard about Tandem VR when Finch was admitted to the home care program. With the virtual experiences tailored to each patient, Finch he could virtually revisit places like Las Vegas and Red Rock Canyon in Nevada and Huntington Beach, California. 

“Those were areas Dad talked about over the years,” Dwiggins told The Journal. “He lived in Las Vegas for over 30 years, rode his Harley all through the canyons and up along the coast, and talked about the sunsets at Huntington Beach. It’s been 6 years since Dad has been back there, and he has been trying to get back to visit but his health prevented him to getting back. This program at least allowed him to reminisce the good times he had.”

The experience was made even more special because with Tandem VR, Dwiggins could join Finch.

“It was exciting and emotional at the same time just to be able to virtually stand on the sidewalk on the main strip in Vegas and to watch the dancing water in front of the Bellagio Hotel where we once stood together during a visit,” Dwiggins recalled. “Another special moment was when we virtually went through the Red Rock Canyon. It took me back to one of my visits when dad and I took a ride on his Harley and rode through the canyons. I could remember how I wrapped my arms around his waist and how he made sure my helmet was on good. 

“I embraced every minute that day to be in his world that he felt free in,” she added. “The virtual view took me back to that moment I’ll treasure forever.”

Dwiggins said Finch enjoyed seeing those places again, and they were both excited to be back on the strip in Las Vegas.

“I was pointing out things we had not seen in a while and pointing at hotels and retelling stories,” she said. “He too pointed out images and would speak on some good times he had. It was good to hear his excitement. It was a sweet time. I was grateful for this opportunity that allowed him to be able to relive a big part of his life and to think of the good times he had there.”…

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Updated HCPF Guidance on Fee-For-Service Provider Billing in School Settings


HCPF is clarifying and updating February 2024 guidance for community providers billing Medicaid fee-for-service when providing services to students in the school setting.

HCPF has been working with federal partners on this important subject. We received clarification that community providers may be allowed to bill fee-for-service for services provided to children during school hours and while at school.

There are specific requirements for providers to bill for these services, and as such, providers are encouraged to read carefully the May 3, 2024, letter about Community Providers in School Settings linked on the Private Duty Nursing webpage and the Home Health webpage. This information will also be included in the June 2024 Provider Bulletin.

Questions about this important update can be directed to [email protected].


Home Health “Hand Off” Directive Causes Confusion

NAHC Report

NAHC has been receiving questions about an article posted on the PalmettoGBA website, intended for participants in the Home Health Review Choice Demonstration (RCD), regarding a requirement that home health agencies must have a physician-signed statement of a “hand off” occurring when a physician recertifies home health. However, PalmettoGBA applied the requirement to all home health claims under review as did the other Medicare Administrative Contractors (MACs). 

There is not a requirement for a physician-signed “hand off” under any circumstance in home health.  As soon as NAHC became aware of the situation we reached out to CMS (Center for Medicare & Medicaid Services).  Since then, the article has been taken down and, in a meeting, earlier this week where PalmettoGBA and CGS representatives were present, they confirmed that they are not applying the “hand off” requirement as part of RCD or medical review of claims. We understand that the same is true for NGS, but we have reached out to them for confirmation.

CMS as well as PalmettoGBA has indicated that all MACs will be posting a revised article.  No expected timeline has been given.  Based upon discussion at the meeting earlier this week, we anticipate that any reference to a physician-signed “hand off” will be removed from the article. Home health agencies that have had claims denied due to the lack of a “hand off” should appeal those denials. Likewise, home health agencies participating in the pre-claim review option for RCD that have had non-affirmations for this reason, should submit the Document Control Number (DCN) to PalmettoGBA for correction.


FY 2024-25 HCBS Rates Now Posted on HCPF Website


Effective July 1, 2024, all impacted Direct Care Workers, employees, or independent contractors, are required to be paid at a minimum the $17.00 per hour base wage outside of Denver or $18.29 within Denver in alignment with the Denver minimum wage increase. Additionally, Direct Care Workers, who are paid a per diem rate, must have their rate increased by the same percentage of the rate increase as of July 1, 2024. HCBS Providers will receive a 2.0% across-the-board increase on July 1, 2024, as well as targeted rate increases for identified HCBS services. 

The HCBS Rate Schedule can be found on the HCPF Provider Rates and Fee Schedule webpage.

The HCBS Base Wage Direct Care Worker Wage 2024 Attestation Form will be available on July 1, 2024, and due to HCPF by August 30, 2024. Payment holds will begin Sept. 9, 2024, for HCBS providers who are not in compliance with 2024 base wage reporting requirements. All questions related to the 2024 attestation form, process, and payment holds should be directed to [email protected].

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