Kan. Medical Assistance Program Hospice Fee-for-Service Provider Manual § 8400, Covered Services

The following services must be provided:

Core Services

Except physician services, all core services must be provided directly by hospice employees on a routine

basis. These services must be provided in a manner consistent with acceptable standards of practice. The

following are hospice core services:

• Physician services

o Basic payment rates for hospice are designed to reimburse the hospice for the costs of all

covered services related to the treatment of the member’s terminal illness, including the

administrative and general supervisory activities performed by physicians who are employees

of or working under arrangements made with the hospice. These functions are performed by

the physician serving as the medical director and the physician member of the hospice

interdisciplinary group. This includes participation in the establishment, periodic review, and

updating of plans of care, supervision of care and services, and establishment of governing

policies. The costs for these services performed by the physician are included in the

reimbursement rates for the four levels of care.

o Claims submitted by any physician providing direct patient care to a hospice-enrolled

member will be reimbursed. Direct patient care services provided by a hospice physician are

allowable charges that must be billed under the physician’s provider number.

• Nursing services

o Nursing services (routinely available and/or on call on a 24-hour basis, 7 days a week)

provided by or under the supervision of an RN functioning within a plan of care developed by

the hospice IDG in consultation with the patient’s attending physician, if the patient has one.

o To be covered as nursing services, the services must require the skills of an RN, licensed

practical nurse (LPN), or licensed vocational nurse (LVN) under the supervision of an RN

and must be reasonable and necessary for the palliation and management of the patient’s

terminal illness and related conditions.

• Medical social services

Medical social services must be provided by a qualified social worker under the direction of a

physician. Medical social services must be provided by a person who meets the criteria given in

the Conditions of Participation at 42CFR418.114(b)(3).

Covered services of these professionals may include but are not limited to:

o Assessment of the social and emotional factors related to the patient’s illness, need for care,

response to treatment and adjustment to care

o Assessment of the relationship of the patient’s medical and nursing requirements to the

patient’s home situation, financial resources, and availability of community resources

o Appropriate action to obtain available community resources to assist in resolving the

patient’s problem

o Counseling services that are required by the patient

o Medical social services furnished to the patient’s family member or caregiver on a short-term

basis when the hospice can demonstrate that a brief intervention (that is, two or three visits)

by a medical social worker is necessary to remove a clear and direct impediment to the

effective palliation and management of the patient’s terminal illness and related conditions

Note: To be considered “clear and direct,” the behavior or actions of the family member or

caregiver must plainly obstruct, contravene, or prevent the patient’s medical treatment.

Medical social services to address general problems that do not clearly and directly impede

treatment as well as long-term social services furnished to family members, such as ongoing

alcohol counseling, are not covered.

• Counseling services

o Counseling services (including but not limited to bereavement, dietary, and spiritual

counseling) with respect to care of the terminally ill individual and adjustment to death. The

hospice must make bereavement services available to the family and other individuals

identified in the bereavement plan of care up to one year following the death of the patient.

o Counseling services are provided to the terminally ill individual and the family members or

other persons caring for the individual at home. Counseling, including dietary counseling,

may be provided both for the purpose of training the individual’s family or other caregiver to

provide care and for the purpose of helping the individual and those caring for the individual

to adjust to the individual’s approaching death. Bereavement counseling is available to the

patient and his or her immediate family to provide emotional, psychosocial, and spiritual

support and services before and after the death of the patient and to assist with issues related

to grief, loss, and adjustment for up to one year after the patient’s death.

Noncore services

In addition to the hospice core services (physician services, nursing services, medical social services, and

counseling), the following services must be provided by the hospice, either directly or under

arrangements, to meet the needs of the patient and family:

• Physical and occupational therapy and speech language pathology services

Physical therapy, occupational therapy, and speech-language pathology services may be provided

for purposes of symptom control or to enable the individual to maintain activities of daily living

and basic functional skills.

• Hospice aide services

o A hospice aide employed by a hospice, either directly or under contract, must meet the

qualifications required by §1891(a)(3) of the Act and implemented at 42CFR418.76.

o Duties of the hospice aide include personal care, ambulation and exercise, household services

essential to health care at home, assistance with medications that are ordinarily

self-administered, reports of changes in the patient's condition and needs, and appropriate

record completion. Aides may also perform household services to maintain a safe and

sanitary environment in areas of the home used by the patient, such as changing the bed

linens, cleaning, and laundering, which are essential to the comfort and cleanliness of

the patient.

o A hospice aide is assigned to a specific patient by an RN who is a member of the

interdisciplinary group.

o An RN must visit the home site at least every two weeks when aide services are being

provided. This visit must include a written assessment of the aide service.

o Written patient care instructions for a hospice aide must be prepared by the RN who is

responsible for the supervision of a hospice aide.

• Homemaker services

Services to maintain a safe and sanitary environment in areas of the home used by the patient,

such as changing the bed linens, cleaning, and laundering, which are essential to the comfort and

cleanliness of the patient.

• Volunteers

• Medical supplies (including drugs and biologicals on a 24-hour basis) and the use of medical

appliances related to the terminal illness and related conditions

o All drugs related to the terminal illness of the patient are covered by the hospice program and

are included in the daily rate. All drugs not related to the terminal illness or related conditions

for members receiving hospice care require PA.

o A signed statement from the hospice provider will be needed for all drug PA requests for

members assigned to that hospice provider. The statement must include rationale for

noncoverage of the drug(s) by the hospice provider.

o The signed statement from the hospice provider can be faxed or mailed directly to the PA

department or sent to the pharmacy.

• Fax: 1-800-913-2229 or 785-274-5956

• Office of the Fiscal Agent, P.O. Box 3571, Topeka, KS 66601-3571

• Short-term inpatient care (including respite care and interventions necessary for pain control

and acute and chronic symptom management) in a Medicare/Medicaid participating facility

• Home and Community Based Services

o Members receiving hospice services may also be eligible to receive services through the

HCBS program. However, HCBS cannot duplicate services being rendered by the

hospice provider.

o To ensure services are not duplicated and the hospice member is receiving the quality of care

that he or she is entitled to, KMAP may ask for written care plans from hospice and HCBS

providers. Hospice is the coordinator of all care services that the hospice member receives.

When a member is admitted to hospice services while receiving targeted case management

(TCM) services, providers do not need to obtain PA for TCM services. Care coordination

provided through the hospice benefit and TCM are separate and distinct services and are not

duplicative. Evidence of coordination with other case managers should be reflected in the

hospice plan of care.