La. Medicaid Services Manual ch. 24 (Hospice) § 24.14

Activities of Daily Living (ADLs) – The functions or basic self-care tasks which an individual

performs in a typical day, either independently or with supervision/assistance. ADLs include

bathing, dressing, eating, grooming, walking, transferring and/or toileting.

Adult Day Health Care (ADHC) Waiver – An optional Medicaid program under section 1915

(c) of the Social Security Act that provides services in the community as an alternative to

institutional care to individuals who: are age 65 or older, or aged 22- 64 and have a physical

disability, and meet nursing facility level of care (NFLOC) requirements.

Attending/Primary Physician - A doctor of medicine or osteopathy, fully licensed to practice

medicine in the State of Louisiana, who is designated by the beneficiary as the physician

responsible for their medical care. The attending physician is the physician identified within the

Medicaid system as the provider to which claims have been paid for services prior to the time of

the election of hospice.

Bereavement Counseling - Organized counseling provided under the supervision of a qualified

professional to help the family cope with death related grief and loss issues. This is to be provided

for at least one year following the death of the beneficiary.

BHSF Form Hospice - (Notice of Election (NOE)/Revocation/Discharge/Transfer) - This is

the required form used to notify the hospice Prior Authorization Unit (PAU) of a beneficiary’s

election or cancellation of the hospice program as provided by Louisiana Medicaid. This form is

also used to update changes in the Medicaid hospice beneficiary’s condition and status.

BHSF Form Hospice - Certification of Terminal Illness (CTI) - This is the required form to be

used by the hospice agency for documentation of written and verbal certification of terminal illness

for Medicaid beneficiaries. This form is not to be altered by the Hospice provider. In addition,

this form may be utilized for dually eligible (Medicare/Medicaid) beneficiaries.

Clinical Condition – A diagnosis or beneficiary state that may be associated with more than one

diagnosis, or may be as yet undiagnosed.

Concurrent Care – Beneficiaries who are under 21 years of age and elect hospice are entitled to

receive a hospice benefit while continuing to receive all necessary disease-directed and life-prolonging therapies with the goal of providing access to comprehensive care, in order to live as

long and as well as possible.

Community Choices Waiver (CCW) – An optional Medicaid program under section 1915 (c)

of the Social Security Act that provides services in the community as an alternative to

institutional care to individuals who: are age 65 or older, or aged 21- 64 and have a physical

disability, and meet the NFLOC requirements.

Core Services - Nursing services, physician services, medical social services and counseling

services, including bereavement counseling, dietary counseling, spiritual counseling and any other

counseling services provided to meet the needs of the individual and family.

Curative Treatments – Medical treatment and therapies provided to a beneficiary with the intent

to improve symptoms and cure the patient’s medical problem.

Department/LDH - Louisiana Department of Health.

Discharge - The point at which the beneficiary’s active involvement with the hospice services is

ended and the hospice provider no longer has active responsibility for the care of the beneficiary.

Geographic Area - Area around location of licensed agency which is within a 50-mile radius of

the agency premises.

Hospice Employee - An individual whom the hospice provider pays directly for services

performed on an hourly or per visit basis and the hospice provider is required to issue a form W-2

on their behalf. If a contracting service or another agency pays the individual, and is required to

issue a form W-2 on the individual's behalf, or if the individual is self-employed, the individual is

not considered a hospice employee. An individual is also considered a hospice employee if the

individual is a volunteer under the jurisdiction of the hospice.

Instrumental Activities of Daily Living (IADLs) – Those routine household tasks that are

considered essential for sustaining the individual’s health and safety, but may not require

performance on a daily basis. IADLs may include laundry, meal preparation and storage for the

beneficiary, shopping, light housekeeping, assistance with scheduling and/or accompanying the

beneficiary to medical appointments, etc.

Interdisciplinary Team (IDT) - An IDT designated by the hospice provider, composed of

representatives from all the core services. The IDT must include at least a doctor of medicine or

osteopathy, a registered nurse (RN), a social worker and a pastoral or other counselor. The IDT is

responsible for: participation in the establishment of the plan of care (POC); provision or

supervision of hospice care and services; periodic review and updating of the POC for each

individual receiving hospice care; and establishment of policies governing the day- to-day

provision of hospice care and services.

Level of Care (LOC) - Hospice care is divided into four categories of care rendered to the hospice

beneficiary: (1) routine home care; (2) continuous home care; (3) inpatient respite care; and (4)

general inpatient care.

Life-Prolonging Therapies - Any aspects of the beneficiary’s medical POC that are focused on

treating, modifying, or curing a medical condition so that the beneficiary may live as long as

possible, even if that medical condition is also the hospice qualifying diagnosis. Beneficiaries

under age 21 are entitled to receive life-prolonging therapies in the concurrent care model of

hospice.

Long Term-Personal Care Services (LT-PCS) – A Medicaid state plan service which provides

assistance with ADLs and IADLs as an alternative to instituti onal care to qualified Medicaid

beneficiaries who are age 21 or older and meet specific program requirements.

Non-Core Services - Services provided directly by hospice employees or under arrangement.

These services include, but are not limited to home health aide and homemaker, physical therapy

services, occupational therapy services, speech-language pathology services, inpatient care for

pain control and symptom management and respite purposes, and medical supplies and appliances,

including drugs and biologicals.

Office of Aging and Adult Services (OAAS) – The office within LDH that is responsible for the

management and oversight of certain Medicaid home and community-based services (HCBS)

waiver programs (CCW and ADHC Waiver), state plan programs, adult protective services for

adults ages 18 through 59, and other programs that offer services and supports to the elderly and

adults with disabilities.

Office for Citizens with Developmental Disabilities (OCDD) – The office within LDH that is

responsible for management and oversight of 1915 (c) Medicaid HCBS waiver programs (New

Opportunities Waiver (NOW), Residential Options Waiver (ROW), Supports Waiver (SW), and

Children’s Choice Waiver (CC)) that services individuals of all ages with intellectual and/or

developmental disabilities.

Plan of Care (POC) - A written document established and maintained for each individual admitted

to a hospice program. Care provided to an individual must be in accordance with the POC. The

POC includes an assessment of the individual's needs and identification of the services, including

the management of discomfort and symptom relief.

Program of All-Inclusive Care for the Elderly (PACE) – Program which coordinates and

provides all needed preventive, primary health, acute and long- term care (LTC) services to

qualified beneficiaries age 55 and older in order to enhance their quality of life and allow them to

continue to live in the community.

Relative - For the purpose of legal representation, a relative is all persons related to the beneficiary

by virtue of blood, marriage, adoption or legal guardianship as court appointed.

Service Intensity Add-On (SIA) Rate – A rate for RN and social work er visits provided to a

patient within the last seven days of life.

Support Coordination Agency – For OAAS, this is a n entity which delivers Medicaid support

coordination services under an agreement with LDH/OAAS.

Terminal Illness - A medical prognosis of limited expected survival, of approximately six months

or less at the time of referral to a hospice program, of an individual who is experiencing an illness

for which therapeutic strategies directed toward cure and control of the disease alone are no longer

appropriate.