MHCP Provider Manual, Hospice Services, Medical needs that arise during the period of the hospice

Sometimes members need new health care services in addition to the services offered as part of the hospice benefit. MA-covered services may be provided in response to conditions not related to the terminal condition. Examples of this include treatment for a hip fracture or for a new condition or symptom unrelated to the terminal diagnosis.

Determining when an MA-covered service duplicates a hospice service

Generally, the hospice provider’s responsibility to provide care coordination includes determining whether a service duplicates a hospice benefit service. The hospice care coordinator must assume the lead responsibility for collaborating with the county case manager, home care agency, physician, or other provider providing services that are outside of the hospice benefit.

Because some hospice benefit services and MA-covered services may be similar, this determination process should focus on the purpose, rather than the type of service—that is, which member need is the service addressing?

Refer to the following considerations to help determine the purpose of a service by asking whether it is to:

• Address a preexisting condition or a preexisting need?

• Address a health care problem that would have existed even without the terminal illness?

• Facilitate the member’s ability to live in the community setting rather than an institution; and would that need have been present with or without the terminal illness?