MO HealthNet Hospice Provider Manual § 2.9

The MO HealthNet hospice benefit includes the following covered services provided according to a written plan of care.

Core Services

The core hospice services listed below must be routinely provided directly by appropriately qualified hospice employees. Volunteers are considered hospice employees. A hospice must ensure that substantially all the core services are routinely provided directly by hospice employees. A hospice may use contracted staff, if necessary, to supplement hospice employees to meet the needs of patients during periods of peak patient loads or under extraordinary circumstances. If contracting is used, the hospice must maintain professional, financial, and administrative responsibility for the services and must ensure that the qualifications of staff and services provided meet all requirements.

Nursing care provided by or under the supervision of a RN

Medical social services provided by a social worker who has at least a bachelor’s degree from a school accredited or approved by the Council on Social Work Education and who is working under the direction of a physician

Physician’s services performed by a MD or DO to meet the general medical needs of the participant to the extent that these needs are not met by the attending physician

Counseling services, including dietary counseling, provided to both the participant and the family members or other persons caring for the participant at home. Counseling services must be available and may be provided both for the purpose of training the participant’s family or other caregiver and for the purpose of helping the participant and the caregivers to adjust to the approaching death. These services include the following:

Dietary counseling, when required, must be provided by a qualified individual

Spiritual counseling, including notice to the participant as to the availability of clergy

Counseling provided by members of the interdisciplinary group as well as by other qualified professionals as determined by the hospice

Additional Services

The additional hospice services below are provided, either directly or under arrangement, by the designated hospice. All services must be performed by appropriately qualified personnel and must be specified in the plan of care.

Bereavement services under the supervision of a qualified professional. There must be an organized program for the provision of these services. The plan of care for these services should reflect family needs, as well as a clear delineation of services to be provided and the frequency of service delivery (up to one (1) year following the death of the participant.)

All drugs, prescription, over the counter, and biologicals used primarily for pain or symptom control of the terminal illness

Short term inpatient care required for procedures necessary for pain control or acute or chronic symptom management provided in a participating hospice inpatient unit, participating hospital, NF, or intermediate care home, that additionally meets the special hospice standards regarding staffing and patient areas

Short-term inpatient respite care furnished as a means of providing respite for the participant’s family or other persons caring for the individual at home

The participating hospice inpatient unit, participating hospital, NF, or intermediate care home must meet the special hospice standards regarding staffing and patient areas

Medical appliances and supplies; appliances may include covered durable medical equipment (DME) as well as other self-help and personal comfort items related to the palliation or management of the participant’s terminal illness. Equipment is provided by the hospice for use in the participant’s home while under hospice care. Medical supplies include those that are part of the written plan of care.

Room and board in a MO HealthNet-certified NF or intermediate care home

Home health aide services furnished by certified aides and homemaker services; home health aides may provide personal care services. Aides may also perform household services to maintain a safe and sanitary environment in areas of the home used by the participant, such as changing the bed or light cleaning and laundering essential to the comfort and cleanliness of the participant. Aide services must be provided under the general supervision of a RN. Homemaker services may include assistance in personal care, maintenance of a safe and healthy environment, and services to enable the individual to carry out the plan of care.

Physical therapy, occupational therapy, and speech-language pathology services for purposes of symptom control or to enable the participant to maintain activities of daily living (ADL) and basic functional skills. When provided, the services must be offered in a manner consistent with accepted standards of practice.