Iowa Medicaid Hospice Provider Manual ch. III § B.1

The hospice program includes the following bulleted services. Any of the

services can be combined, by duration or frequency, to meet the daily needs

of the member and family.

• Nursing care. Skilled nursing care must be provided by or under the

supervision of a registered nurse.

A hospice must provide nursing care directly unless a waiver has been

submitted and approved by the Centers for Medicare and Medicaid

Services (CMS).

Nursing care must ensure that the nursing needs of the member are met

as identified in the member’s initial assessment, comprehensive

assessment, and updated assessments.

• Medical social services. Medical social services must be provided by a

qualified social worker, under the direction of a physician.

Social work services must be based on the member’s psychosocial

assessment and the member’s and family’s needs and acceptance of these

services.

• Physician services. Physicians’ services are performed by a physician or

a nurse practitioner with the exception of the hospice medical director or

the physician member of the hospice interdisciplinary team. The hospice

medical director or the interdisciplinary team (IDT) physician must be a

doctor of medicine or osteopathy.

The hospice medical director, physician employees, and contracted

physicians of the hospice, in conjunction with the member’s attending

physician, are responsible for the palliation and management of the

terminal illness and conditions related to the terminal illness.

All physician employees and physicians under contract are under the

supervision of the hospice medical director.

All hospice physicians shall coordinate care with the attending physician, if

the member chooses an attending physician outside of the hospice

network. If the attending physician is unavailable, the hospice medical

director, hospice physician or contracted physician shall coordinate care.

• Spiritual counseling. Spiritual counseling must provide the following:

• An assessment of the member’s and family’s spiritual needs.

• Meet needs in accordance with the member and family’s acceptance of

this service and in a manner consistent with member and family beliefs

and desires.

• Make all reasonable efforts to facilitate visits by local clergy, pastoral

counselors, or other individuals who can support the member’s

spiritual needs.

• Advise the member and family of this service.

• Dietary counseling. Dietary counseling is provided by a qualified

professional who is able to address and assure that the identified dietary

need of a hospice member is met.

• Bereavement counseling. Bereavement counseling is a required

service but is not reimbursable.

Services must be provided under the supervision of a qualified

professional with experience or education in grief or loss counseling.

Bereavement services are available to the family and other individuals in

the bereavement plan of care up to one year following the death of the

member. Bereavement counseling may also be provided to residents of:

• A skilled nursing facility (SNF),

• A nursing facility (NF), or

• An intermediate care facility for the intellectually disabled (ICF/ID).

• Hospice aide. Hospice aides provide personal care services and

household services to maintain a safe and sanitary environment in areas

of the home used by the member, such as changing the bed or light

cleaning and laundering essential to the comfort and cleanliness of the

member. Hospice aide services must be provided under the general

supervision of a registered nurse.

• Homemaker. Homemaker services may include assistance in personal

care, maintenance of a safe and healthy environment, and services to

enable the hospice aide to carry out the plan of care.

• Physical therapy, occupational therapy, and speech-language

pathology. Physical therapy, occupational therapy, and speech-language

pathology services are provided for purposes of symptom control or to

enable the member to maintain activities of daily living and basic

functional skills.

• Volunteer services. Volunteers must provide day-to-day administrative

or direct member care services in an amount that, at a minimum, equals

five percent of the total member care hours of all paid hospice employees

and contract staff.

The hospice must maintain records on the use of volunteers for member

care and administrative services, including the type of services and time

worked.

• Short-term inpatient care. Short-term inpatient care is provided in a

participating hospital. Services provided in an inpatient setting must

conform to the written hospice plan of care. General inpatient care may

be required for procedures necessary for pain control or acute or chronic

symptom management which cannot be provided in other settings.

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

family or other persons caring for the member at home. Respite care is

the only type of inpatient care that may be provided in a nursing facility

when the member is otherwise receiving hospice services in a home

setting.

• Medical supplies and medical equipment. Medical supplies include

drugs and biologicals. Only drugs which are used primarily for the relief

of pain and symptom control related to member’s terminal illness are

covered.

Medical equipment includes durable medical equipment and other self-help and personal comfort items related to the palliation or management

of the member’s terminal illness. Equipment is provided by the hospice

for use in the member’s home while the member is under hospice care.

Medical supplies include those that are part of the written hospice plan of

care.

• Other services. Any other service that is medically necessary for the

palliation and management of the member’s terminal illness and related

conditions and for which reimbursement may otherwise be made under

Iowa Medicaid or IA Health Link MCO shall be covered under the hospice

program.