AHCCCS Medical Policy Manual, Policy 310-J, § III.B

Hospice services provide palliative and support care for terminally ill members and their

family members and/or caregivers in order to ease the physical, emotional, spiritual, and

social stresses, which are experienced during the final stages of illness and during dying and

bereavement.

1. When the conditions of participation are met as specified in 42 CFR Part 418, hospice

services are provided in the member’s own home, or the following inpatient settings:

a. Hospital,

b. Nursing care institution, and

c. Free standing hospice unit.

2. The Hospice providers shall also have social services, counseling, dietary services, homemaker,

personal care, and home health aide services, and inpatient services available as necessary to

meet the member‘s needs. The following bundled hospice services are covered when provided

in approved settings:

a. Physicians’ services for the treatment of the member’s terminal illnesses and related

administrative and general supervisory activities, except for attending physician

services provided by non-hospice employees,

b. Continuous home care,

c. Dietary services, which include a nutritional evaluation and dietary counseling when

necessary,

d. Home health aide services,

e. Homemaker services,

f. Nursing services provided by or under the supervision of a registered nurse,

g. Pastoral/counseling services provided by an individual who is qualified through the

completion of a degree in ministry, psychology, or a related field and who is

appropriately licensed or certified,

h. Hospice respite care services which are provided on an occasional basis, not to

exceed more than five consecutive days at a time. Respite care may not be provided

when the member is a nursing facility resident or is receiving services in an inpatient setting,

i. Routine home care,

j. Social services provided by a qualified social worker,

k. Therapies that include physical, occupational, and/or speech therapy,

l. A 24 hour on-call availability to provide services such as reassurance, information,

and referral for members and family members and/or caregivers,

m. Volunteer services provided by individuals who are specially trained in hospice and

who are supervised by a designated hospice employee. Pursuant to 42 CFR 418.70,

if providing direct patient care, the volunteer shall meet qualifications required to

provide such service(s),

n. Medical supplies, appliances, and equipment, including:

i. Pharmaceuticals, which are used in relationship to the palliation or management

of the member’s terminal illness, and

ii. Medical equipment and appliances may include but are not limited to:

a) Wheelchairs,

b) Hospital beds, and/or

c) Oxygen equipment.

3. Bereavement counseling to the member‘s family and/or caregiver both before and up to

12 months following the death of that member. Bereavement counseling, to the

member’s family and or/caregiver both before and up to 12 months following the death of

the member, is part of the bundled hospice services and is not separately reimbursable, as

specified in 42 CFR 418.204.