Ind. IHCP Hospice Services Provider Reference Module, Section 5, Hospice Plan of Care Documentation Requirements

Providers should see 42 CFR 418.56 for the pertinent regulations for the hospice plan of care.

The following information reminds providers of Medicare’s requirements for the development of the plan

of care. This information also includes clarification from the IDOH on questions regarding standing orders

in nursing facilities and how to document provided-when-necessary (PRN) services.

• The plan of care must be established before rendering services. The plan of care must be dated on

the day it is first established.

➢ The basic interdisciplinary team member who first assesses the patient’s needs must meet or call

at least one other group member (nurse, physician, medical social worker or counselor) before

writing the initial plan of care. At least one of the persons involved in developing the plan of

care must be a nurse or physician.

➢ The other two members of the basic interdisciplinary team (attending physician and medical

director) must review the initial plan of care and provide their input within two days of

assessment. This input may be provided by telephone.

➢ The plan of care must include an assessment of the individual’s needs and identification of the

services including the management of discomfort and symptom relief. It must state in detail the

scope and frequency of services needed to meet the patient’s and family’s needs.

Note: Hospice providers are reminded, as the IDOH stated during an interdisciplinary

group (IDG) meeting, that the hospice should note PRN times the number of visits.

Frequency must be provided using the formula “range plus PRN.” Zero is not

acceptable to use when establishing a range.

➢ The plan of care should include only services that are reasonable and necessary for the palliation

and management of the terminal illness and related conditions:

o The hospice interdisciplinary team (including consultation with attending physician and

medical director) should decide which services are related or not related to the individual

patient’s terminal condition.

o The hospice interdisciplinary team decides what services are necessary for palliation and

what services are considered curative, and therefore, noncovered (except for authorized

curative treatment for children). Chemotherapy, radiation therapy and other modalities may

be used for palliative purposes if the hospice determines that these services are needed for

palliation. This determination is based on the patient’s condition and the hospice’s caregiving

philosophy. There is no additional Medicare (or Medicaid) reimbursement for these services.

➢ The plan of care must be reviewed and updated at intervals specified in the plan of care. It

should be continually assessed to ensure the care the patient receives meets their needs and to

verify that the patient continues to be appropriate for hospice benefits. The plan of care should

be updated if the patient’s condition improves or deteriorates, and if the level of care changes.

➢ The plan of care sent to the Medicaid PA-UM contractor must reflect all three signatures of the

interdisciplinary team members on the same plan of care.