Ind. IHCP Hospice Services Provider Reference Module, Section 5, Plan of Care for Concurrent Hospice and Curative Care Services for Children

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 submitted to the PA-UM contractor.

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.

When a member elects concurrent hospice and curative care services, providers must develop a comprehensive

plan of care. The plan of care is subject to the requirements outlined in 405 IAC 5-34-7 and must be:

• Prepared and agreed on by the hospice interdisciplinary team and the providers rendering the

curative care. The plan of care must:

➢ Provide an assessment of the member’s needs.

➢ Identify and delineate the hospice and curative care services, and the manner in which the

services and assessments are coordinated.

➢ Identify the curative care services and hospice services, and the scope and frequency of the

services.

➢ Include the criteria for terminating curative care services.

• The plan of care must be reviewed and updated (as identified in the plan of care) and include:

➢ Verification that the member’s needs are being met

➢ Verification that the patient continues to be appropriate for hospice Medicaid benefit

• 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 and advance directive must be included in the hospice and curative care provider’s

medical charts.

Providers rendering curative services under the plan of care are responsible to obtain prior authorization for

their services, when needed, and to bill for curative services. The hospice plan of care and the curative plan

of care must be submitted to the IHCP PA-UM contractor to ensure a comprehensive review.