MHCP Provider Manual, Hospice Services, Preexisting health care needs

The member may already need and have in place some MA-covered services for preexisting medical conditions or disability before seeking hospice. The hospice benefit is not intended to duplicate health services or supports that relate to a preexisting condition. Examples of services that may already be in place include continuing care services such as home care related to a previous stroke, waiver services related to a disability, or adult foster care related to a disability such as elderly dementia. Examples of preexisting medical care include services for conditions such as diabetes, ALS, arthritis, cardiac conditions, AIDS, or high blood pressure.

Preexisting continuing care services may need to be adjusted during the period that the member is receiving the hospice benefit. Members with preexisting needs, such as quadriplegia or stroke, may have more intensive physical needs due to the terminal illness than do people without such preexisting conditions. The resulting higher needs are an interaction of the two conditions, some of which may need to be addressed through increased continuing care services.