Del. Medical Assistance Program Hospice Provider Specific Policy Manual § 2.2

2.2.1 All services must be performed by appropriately qualified personnel, but it is the

nature of the service, rather than the qualification of the person who provides it,

that determines the coverage category of the service. The following are covered

hospice services:

• Nursing care provided by or under the supervision of a registered nurse.

• Medical social services provided by a social worker who has at least a

bachelor’s degree from a school accredited or approved by the Council on

Social Work Education, and who is working under the direction of a physician.

• Physician’s services performed by a physician except that the services of the

hospice medical director or the physician member of the interdisciplinary

group must be performed by a doctor of medicine or osteopathy.

• Counseling services provided to the terminally ill individual and the family

members or other persons caring for the individual at home. Counseling,

including dietary counseling, may be provided both for the purpose of training

the individual’s family or other caregiver to provide care, and for the purpose

of helping the individual and those caring for him or her to adjust to the

individual’s approaching death.

• Short-term inpatient care provided in a participating hospice inpatient unit, or

a participating hospital or nursing facility that additionally meets the special

hospice standards regarding staff and patient areas. Services provided in an

inpatient setting must conform to the written plan of care. General inpatient

care may be required for procedures necessary for pain control or acute or

chronic symptom management that cannot be provided in other settings.

Inpatient care may also be furnished to provide respite for the individual’s

family or other person caring for the individual at home.

• Medical appliances and supplies including drugs and biologicals. Only drugs

as defined in §1861(t) of the Social Security Act and which are used primarily

for the relief of pain and symptom control related to the individual’s terminal

illness are covered. Appliances may include covered durable medical

equipment as well as other self-help and personal comfort items related to

the palliation or management of the patient’s terminal illness. Equipment is

provided by the hospice for use in the patient’s home while he or she is

under hospice care. Medical supplies include those that are part of the

written plan of care.

• Home health aide services furnished by qualified aides and

homemaker services. Home health aides may provide personal care

services. Aides may also perform household services to maintain a

safe and sanitary environment in areas of the home used by the patient such

as changing the bed or light cleaning and laundering essential to the comfort

and cleanliness of the patient. Aide services must be provided under the

general supervision of a registered nurse. Homemaker services may include

assistance in personal care, maintenance of a safe and healthy environment

and services to enable the individual to carry out the plan of care.

• Physical therapy, occupational therapy and speech-language pathology

services provided for purposes of symptom control or to enable the individual

to maintain activities of daily living and basic functional skills.

2.2.2 Nursing care, physicians’ services, medical social services and counseling are

core hospice services and must routinely be provided directly by hospice

employees. Supplemental services may be contracted during periods of peak

patient loads and to obtain physician specialty services.