Mont. Medicaid Hospice Policy Manual, Policy 701

The hospice must be licensed under state law and must meet

Medicare’s conditions of participation for hospice programs and

have a valid provider agreement with Medicare as a condition of

enrollment in Medicaid.

A hospice must routinely provide substantially all core services

directly by hospice employees. These services must be provided in

a manner consistent with acceptable standards of practice. These

services include nursing services, medical social services, and

counseling.

The hospice may contract for physician services as specified in the

“Physician Services,” section. A hospice may use contracted staff, if

necessary, to supplement hospice employees in order to meet the

needs of members under extraordinary or other non-routine

circumstances. A hospice may also enter into a written

arrangement with another Medicaid certified hospice program for

the provision of core services to supplement hospice

employee/staff to meet the needs of members.

Circumstances under which a hospice may enter into a written

arrangement for the provision of core services include:

1. Unanticipated periods of high patient loads,

staffing shortages due to illness or other short-term temporary situations that interrupt

member care; and

2. Temporary travel of a member outside of the

hospice's service area.

PHYSICIAN

SERVICES

The hospice medical director, physician employees, and contracted

physician(s) of the hospice, in conjunction with the member's

attending physician, are responsible for the palliation and

management of the terminal illness and conditions related to the

terminal illness.

All physician employees and those under contract must function

under the supervision of the hospice medical director;

All physician employees and those under contract shall meet this

requirement by either providing the services directly or through

coordinating member care with the attending physician; and

If the attending physician is unavailable, the medical director,

contracted physician, and/or hospice physician employee is

responsible for meeting the medical needs of the member.

NURSING

SERVICES

The hospice must provide nursing care and services by or under

the supervision of a registered nurse. Nursing services must ensure

that the nursing needs of the member are met as identified in the

member's initial comprehensive assessment, and updated

assessments.

NOTE: Highly specialized nursing services that are

provided so infrequently that the provision of

such services by direct hospice employees

would be impracticable and prohibitively

expensive, may be provided under contract.

Waiver of requirement that substantially all nursing services be

routinely provided directly by a hospice.

If a hospice is located in a non-urbanized area, the hospice must

provide the Department with evidence that it has made a good faith

effort to hire a sufficient number of nurses to provide services. The

Department may waive the requirement that nursing services be

furnished by employees based on the following:

1. The location of the hospice’s central office is in a non-urbanized area as determined by the Bureau of

Census; and

2. There is evidence that a hospice was operational on

or before January 1, 1983, including the following:

a. Proof the organization was established

to provide hospice services on or before

January 1, 1983;

b. Evidence that hospice-type services

were furnished to members on or before

January 1, 1983; and

c. Evidence that hospice care was a

discrete activity rather than an aspect of

another type of provider’s patient care

program on or before January 1, 1983.

3. The hospice made a good faith effort to hire nurses as

evidenced by the following:

a. Copies of advertisements in local

newspapers that demonstrate

recruitment efforts;

b. Job descriptions for nurse employees;

c. Evidence that salary and benefits are

competitive in the area; and

d. Evidence of any other recruiting

activities (for example, recruiting efforts

at health fairs and contacts with nurses

at other providers in the area).

Any waiver request is deemed to be granted unless it is denied

within 60 days after it is received.

Waivers will remain in effect one year at a time from the date of

request.

If a hospice wishes to receive a one year extension, it must submit

a request to the Department before the expiration of the waiver

period, and certify that the conditions under which it originally

requested the initial waiver have not changed since the initial

waiver was granted.

MEDICAL

SOCIAL

SERVICES

Medical social services must be provided by a qualified social

worker, under the direction of a physician. Social work services

must be based on the member's psychosocial assessment and the

members and family's needs and acceptance of these services.

COUNSELING

SERVICES

Counseling services must be available to the member and family to

assist the member and family in minimizing the stress and

problems that arise from the terminal illness, related conditions, and

the dying process. Counseling services must include, but are not

limited to, the following:

Bereavement Counseling

The hospice must:

a. Have an organized program for the provision of

bereavement services furnished under the

supervision of a qualified professional with

experience or education in grief or loss

counseling;

b. Make bereavement services available to the

family and other individuals in the bereavement

plan of care up to one year following the death

of the member. Bereavement counseling also

extends to residents of a SNF/NF or ICF/IID

when appropriate and identified in the

bereavement plan of care;

c. Ensure that bereavement services reflect the

needs of the bereaved; and

d. Develop a bereavement plan of care that notes

the kind of bereavement services to be offered

and the frequency of service delivery. A special

coverage provision for bereavement

counseling is specified in Policy 502.

Spiritual Counseling

The hospice must:

a. Provide an assessment of the member's and

families’ spiritual needs.

b. Provide spiritual counseling to meet these

needs in accordance with the member's and

family's acceptance of this service, and in a

manner consistent with member and family

beliefs and desires.

c. M ake all reasonable efforts to facilitate visits by

local clergy, pastoral counselors, or other

individuals who can support the member's

spiritual needs to the best of its ability.

d. Advise the member and family of this service.

Dietary Counseling

Dietary counseling, when identified in the plan of care, must

be performed by a qualified individual, who includes

dietitians as well as nurses and other individuals who are

able to address and assure that the dietary needs of the

member are met.