Mont. Medicaid Hospice Policy Manual, Policy 501

COVERED

SERVICES

All services must be performed by appropriately qualified

personnel, but it is the nature of the service, rather than the

qualification of the person who provides it, that determines the

coverage category of the service. The following services are

covered hospice services:

1. Nursing care provided by or under the supervision of

a registered nurse.

2. Medical social services provided by a social worker

under the direction of a physician.

3. Physicians' services performed by a physician as

defined in Hospice Policy 414 and Policy 701 of this

manual except that the services of the hospice

medical director or the physician member of the

interdisciplinary group must be performed by a doctor

of medicine or osteopathy.

4. Counseling services provided to the terminally ill

member and the family members or other persons

caring for the member at home. Counseling, including

dietary counseling, may be provided both for the

purpose of training the member's family or other

caregiver to provide care, and for the purpose of

helping the member and those caring for him or her to

adjust to the member's approaching death.

5. Short-term individual care provided in a participating

hospice individual unit, or a participating hospital or

SNF. Services provided in an individual setting must

conform to the written plan of care. Individual care

may be required for procedures necessary for pain

control or acute or chronic symptom management.

Individual care may also be furnished as a means of

providing respite for the member's family or other

persons caring for the member at home. Respite care

must be furnished as specified in Hospice policy 711.

Payment for individual care will be made at the rate

appropriate to the level of care. Please refer to the

Hospice fee schedule which can be accessed at

http://www.medicaidprovider.mt.gov.

6. Medical appliances and supplies, including drugs and

biologicals. Only drugs which are used primarily for

the relief of pain and symptom control related to the

member's terminal illness are covered. Appliances

may include covered durable medical equipment as

well as other self-help and personal comfort items

related to the palliation or management of the

member's terminal illness. Equipment is provided by

the hospice for use in the member's home while he or

she is under hospice care. Medical supplies include

those that are part of the written plan of care and that

are for palliation and management of the terminal or

related conditions.

7. Home health or hospice aide services furnished by

qualified aides and homemaker services. Home

health aides (also known as hospice aides) may

provide personal care services. Aides may perform

household services to maintain a safe and sanitary

environment in areas of the home used by the

member, such as changing bed linens or light

cleaning and laundering essential to the comfort and

cleanliness of the member.

Aide services must be provided under the general

supervision of a registered nurse. Homemaker

services may include assistance in maintenance of a

safe and healthy environment and services to enable

the member to carry out the treatment plan.

8. Physical therapy, occupational therapy and speech-language pathology services provided for purposes of

symptom control or to enable the member to maintain

activities of daily living and basic functional skills.

9. Any other service that is specified in the member's

plan of care as reasonable and necessary for the

palliation and management of the member's terminal

illness and related conditions and for which payment

may otherwise be made under Medicare.