Sec. 10.09.35.06. Covered Services

A. Hospice care includes the services listed in §B of this regulation when the services are:

(1) Provided to an eligible recipient who elects hospice care, in accordance with Regulation .05 of this chapter;

(2) Reasonable and necessary for the palliation or management of the participant's terminal illness and related conditions;

(3) Consistent with the plan of care established before the services are provided;

(4) Provided by appropriately qualified personnel;

(5) Administered according to accepted standards of practice; and

(6) Routinely provided directly by provider employees, when they are the core services listed in §B(1)-(4) of this regulation, except that the provider may contract for supplemental services during peak patient loads, under extraordinary circumstances, or to obtain physician specialty services.

B. The following are covered hospice care services:

(1) Nursing care provided by a nurse licensed as a registered nurse in the jurisdiction in which services are provided or by an individual under the supervision of a registered nurse;

(2) Medical social services provided by a social worker who is:

(a) In compliance with the social work licensing requirements of the jurisdiction in which service is provided; and

(b) Working under the direction of a physician;

(3) Physician services performed by a physician as described in 42 CFR §§410.20-410.25, except that the services of the provider's medical director or physician member of the interdisciplinary group shall be performed by a doctor of medicine or osteopathy;

(4) Counseling services provided to the participant and the family members or other persons caring for the participant at home, including:

(a) Dietary counseling;

(b) Counseling to train the participant's family or other caregivers in providing care;

(c) Spiritual counseling to help the participant and the family or other caregivers in the home to adjust to the participant's approaching death;

(d) Bereavement counseling for the family after the participant's death; and

(e) Additional counseling provided by interdisciplinary group members, as well as by other qualified professionals as necessary;

(5) Short-term inpatient care subject to the following conditions:

(a) General inpatient care may be provided to meet the participant's needs for pain control or for acute or chronic symptom management that cannot be met in other settings;

(b) Inpatient respite care may be furnished to provide rest or relief for family members or other individuals routinely furnishing at-home care to the participant; and

(c) General inpatient care and inpatient respite care shall be provided in a:

(i) Hospice that meets the conditions of participation for providing inpatient care directly as set forth in 42 CFR §418.100; or

(ii) Hospital, skilled nursing facility, or nursing facility that meets the special hospice standards regarding 24-hour nursing service and patient areas as set forth in 42 CFR §418.100(a) and (e);

(6) Medical appliances and supplies, including drugs and biologicals, which are needed for the palliation and management of the terminal illness and related conditions;

(7) Home health aide and homemaker services furnished by qualified individuals, who are under the general supervision of a registered nurse; and

(8) Physical therapy, occupational therapy, and speech-language pathology services provided by qualified individuals for purposes of symptom control or to enable the participant to maintain activities of daily living and basic functional skills.