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WASHINGTON -- The government plans to issue rules Thursday for providing hospice care to dying Medicare patients, and Health Secretary Margaret Heckler said they preserve the hospice movement's 'special spirit.'
The rules carry out a law allowing Medicare to finance such care under a three-year experiment that begins Nov. 1.
Mrs. Heckler, secretary of the Health and Human Services Department, said the rules include a $4,232 ceiling on the amount Medicare will pay for any one hospice patient, but President Reagan will sign a bill raising that limit to $6,500.
Hospices provide home care and relief of pain and suffering, but do not attempt cures. The government estimates there are 1,200 in operation or planned nationwide. Officials said only one, in Connecticut, provides institutional care and it will be covered by the new rules.
'I support the goals of hospice care and was very concerned that the special spirit that the hospice movement presently embodies be preserved in the regulatory process,' said Mrs. Heckler.
'It's important to have an alternative to the traditional modes of caring for the terminally ill, and hospices will provide that choice.'
She said the rules will provide 'fair compensation' to hospices.
Mrs. Heckler was interviewed Tuesday, but requested release of her remarks be delayed until the eve of the new regulations.
The Reagan administration was heavily criticized for the lower Medicare ceiling when a draft of the rules was leaked in May. But Mrs. Heckler said the blame was unfair because 'this department had followed the letter of the law' and used the cost formula it required.
Congress approved the higher ceiling before beginning its August vacation.
Hugh Westbrook, spokesman for the National Hospice Organization, said the natio's major hospice group is 'generally pleased' by changes made since the draft rule was leaked.
'We've come from zero to somewhere,' Westbrook said in a telephone interview from his Miami office, although he reserved further comment until he had seen the rules.
The government estimates the hospice benefit will cost Medicare $365 million over three years -- in contrast to Congressional Budget Office projections forecasting a savings because of lower payments for high-technology hospital care.
Budget director David Stockman had opposed the benefit because of the cost, but 'he has reconciled to this,' Mrs. Heckler said.
Officials project only 31,000 Medicare beneficiaries will sign up for hospice care in 1984, with the number rising to 45,000 a year by 1986 -- perhaps 10 percent of those eligible.
Mrs. Heckler, however, said she thinks the number will be higher, adding, 'It's going to become a very popular program if it's implemented well.'
Medicare patients who want the voluntary hospice benefit must have their doctors certify they are expected to live less than six months. They must give up regular Medicare hospital benefits in return for a package of hospice care.
That package includes home health services, counseling, outpatient drugs -- a service not usually provided by Medicare, plus emergency short-term hospital care and 'respite care' to give the patient's family a break from round-the-clock duty.
Mrs. Heckler recalled that when she was in law school, she cared for her own dying grandmother and the strain caused her to suffer a mild virus for three months afterward. 'That burden becomes very heavy,' she said, adding that respite care would have been welcome.
A sponsor of hospice legislation when she was in Congress, Mrs. Heckler said the rules have safeguards to prevent hospices from becoming overly commercial, instead emphasizing the use of volunteers and spiritual counseling.
The rules set average daily payment rates, indexed to wages in the local area. Mrs. Heckler said they are based on government figures on hospice costs.
'It will never be as generous as the hospice groups would like,' she said. 'But it is, I think, fair.'
The government planned to make the rules public Thursday and publish them in the Federal Register next week for 30 days of comment.