Ind. IHCP Hospice Services Provider Reference Module, Section 1, Covered Services in the IHCP Hospice Per Diem

In accordance with Indiana Administrative Code 405 IAC 5-34-8, services covered in the IHCP hospice per

diem reimbursement rates include the following:

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

• Medical social services provided by a social worker who has a bachelor’s degree or higher and who

is working under the supervision of a physician

• Physician services provided by the medical director or physician member of the interdisciplinary

team, characterized as follows:

➢ General supervisory services

➢ Participation in the establishment of the plan of care

➢ Supervision of the plan of care

➢ Periodic review

➢ Establishment of governing policies (for example, services covered by hospice per diem revenue

codes 650, 651, 652, 655 and 658)

• Counseling services provided to the member and the member’s family or other person caring for the

member

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

facility subject to the limitations in 405 IAC 1-16-3

• Medical appliances and supplies, including palliative drugs related to the palliation or management

of the member’s terminal illness

• Home health services furnished by qualified aides

➢ The Medicare home health condition of participation at 42 CFR 484.36 defines the skills,

attitude and training requirements of home health aides

➢ The Medicare hospice condition of participation at 42 CFR 418.76 defines the training,

supervision and duties of the hospice aide.

• Homemaker services that assist in providing a safe and healthy environment

➢ The hospice must ensure that the instructions for homemaker services are noted in the hospice

plan of care, and the proper supervision, reporting and documentation requirements are met as

required by 42 CFR 418.76.

• Physical therapy, occupational therapy and speech-language pathology services provided for

symptom control

• Inpatient respite care, subject to the limitations in 405 IAC 1-16-2

• Room and board for dually eligible (Medicare and Medicaid) hospice members residing in nursing

facilities as covered by hospice per diem revenue code 659, as described in 405 IAC 1-16-4

• Room and board for Medicaid-only hospice members residing in nursing facilities as covered by

hospice per diem revenue codes 650 or 658, as described in 405 IAC 1-16-4

• Any other item or service specified in the member’s hospice plan of care, if the item or service is a

covered service under the Medicare program

For an individual to receive IHCP-covered hospice services, a physician must certify in writing that the

individual is terminally ill and expected to die from that illness within six months, if the terminal illness runs

its normal course (see Section 3: Member Eligibility for Hospice Services). Services provided in hospice

care must be reasonable and medically necessary for the palliation or management of the terminal illness.

Note: IHCP-enrolled children 20 years of age and under who elect the IHCP hospice

benefit may also receive curative care services for the terminal condition, concurrent

with hospice care. Curative services must be medically necessary and included as

part of the hospice plan of care, as described in the Plan of Care for Concurrent

Hospice and Curative Care Services for Children section. When the IHCP member

elects concurrent hospice and curative care benefits, the palliation and management

of the terminal condition comes under the supervision of the IHCP hospice provider.

Curative care services are covered separately from hospice services.