Idaho Medicaid Provider Handbook, Home Health and Hospice Services § 4.4

Hospice services reasonable and necessary for the palliation and management of the terminal

illness and related conditions are a covered benefit of Idaho Medicaid. The hospice agency is

responsible for the overall management and coordination of the hospice Plan of Care including

billing processes. It is the agency’s responsibility to inform other providers the participant is

on hospice. The hospice plan of care supersedes any other Medicaid provider plan of care.

Rehabilitative services, such as community-based rehabilitation service, are not covered once

hospice is elected. However, participants under age 21 are eligible for concurrent curative

treatments and hospice. This means that children are not limited to palliative treatment only.

Core services must be provided by hospice employees except when it is necessary to contract

such services during peak patient loads, staffing shortages from illness, other short-term

temporary situations that interrupt patient care, temporary travel of the participant outside

the hospice’s service area, nursing services so infrequent that employment would be

impractical and prohibitively expensive, or to obtain physician services. A hospice may

contract another hospice enrolled with Medicaid to provide core services. Core services

include:

•

Physician services under the supervision of the Medical Director;

•

Nursing services under the supervision of a registered nurse;

•

Medical social services under the direction of a physician;

•

Counseling services for the participant and family:

o

Bereavement counseling for the family up to a year after the death of the

participant, includes residents of SNF and intermediate care facilities for

individuals with intellectual disabilities (ICF/IID);

o

Dietary counseling; and

o

Spiritual counseling.

Other hospice services, which are the responsibility of the agency regardless of the service

location, include:

•

Nursing care provided by, or under the supervision of, a registered nurse (RN);

•

Medical social services under the direction of a physician;

•

Counseling services for the care of the participant or the acceptance of death;

•

Home health aide and homemaker services;

•

Occupational therapy, physical therapy, and speech-language pathology services;

•

Medical equipment and supplies including:

o

Durable medical equipment and supplies related to the palliation or

management of the patient’s terminal illness; and

o

Self-help and personal comfort items related to the palliation or management

of the patient’s terminal illness; and

•

Drugs and biologicals, as defined in Subsection 1861(t) of the Social Security Act,

which are used primarily for the relief of pain and symptoms related to the patient’s

terminal illness.

Home health aide and homemaker services must be furnished by qualified aides under the

supervision of an RN. Home health aides will provide personal care services and household

services necessary to maintain a safe and sanitary environment in areas used by the

participant. Homemaker services assist in maintenance of a safe and healthy environment.

Short-term inpatient care can be provided in a hospice inpatient unit or participating hospital

or nursing facility with 24 hour nursing care that meets CMS standards for staff, and patient

areas. The services must align with the plan of care. General inpatient care can be provided

for necessary pain control or acute or chronic symptom management that cannot be provided

in other settings. Inpatient care is also covered for the participant’s family or other caregivers

to receive respite.

Certified family homes (CFH), ICF/IIDs, residential assisted living facilities (RALF), and skilled

nursing facilities (SNF) with hospice participants must have a written agreement with the

hospice agency to delineate management responsibilities for the participant’s care.

•

The ICF/IID facility has responsibility for room and board including all assistance in

the activities of daily living (ADL), social activities, administration of medication,

maintaining the cleanliness of a resident’s room, and supervision and assisting in the

use of durable medical equipment and prescribed therapies.

•

The RALF room and board reimbursement is not the responsibility of the hospice

agency.