Mont. Medicaid Hospice Policy Manual, Policy 711

SHORT-TERM

INPATIENT CARE

Inpatient care must be available for pain control, symptom

management, and respite purposes, and must be provided in a

participating Medicaid facility.

INPATIENT CARE

FOR SYMPTOM

MANAGEMENT

AND PAIN CONTROL

Inpatient care for pain control and symptom management must be

provided in one of the following:

1. A Medicare-certified hospice that meets the

conditions of participation for providing inpatient care

as found in 42 CFR 418.110; or

2. A Medicare-certified hospital or a skilled nursing

facility that also meet the standards as found in 42

CFR 418.110.

INPATIENT CARE FOR

RESPITE PURPOSES

Inpatient care for respite purposes must be provided by one of the

following:

1. A Medicaid –certified hospice that meets the

conditions as found in 42 CFR 418.110; or

2. A Medicaid-certified nursing facility that also

meets the standards as found in 42 CFR

418.110.

The facility providing respite care must provide 24-hour nursing

services that meet the nursing needs of all members and are

furnished in accordance with each member's plan of care. Each

member must receive all nursing services as prescribed and must

be kept comfortable, clean, well-groomed, and protected from

accident, injury, and infection.

INPATIENT CARE

PROVIDED UNDER

ARRANGEMENTS

If the hospice has an arrangement with a facility to provide for

short-term inpatient care, the arrangement is described in a written

agreement, coordinated by the hospice, and at a minimum

specifies:

1. That the hospice supplies the inpatient provider a

copy of the member's plan of care and specifies the

inpatient services to be furnished;

2. That the inpatient provider has established member

care policies consistent with those of the hospice and

agrees to abide by the palliative care protocols and

plan of care established by the hospice for its

members;

3. That the hospice member's inpatient clinical record

includes a record of all inpatient services furnished

and events regarding care that occurred at the facility;

that a copy of the discharge summary be provided to

the hospice at the time of discharge; and that a copy

of the inpatient clinical record is available to the

hospice at the time of discharge;

4. That the inpatient facility has identified an individual

within the facility who is responsible for the

implementation of the provisions of the agreement;

5. That the hospice retains responsibility for ensuring

that the training of personnel who will be providing the

member's care in the inpatient facility has been

provided and that a description of the training and the

names of those giving the training are documented;

and

6. A method for verifying that the requirements in

paragraphs 1 through 5 of this section are met.

INPATIENT CARE

LIMITATION

The total number of inpatient days used by Medicare beneficiaries

who elected hospice coverage in a 12-month period in a particular

hospice may not exceed 20 percent of the total number of hospice

days consumed in total by this group of beneficiaries.

EXEMPTION FROM

LIMITATION

Before October 1,1986, any hospice that began operation before

January 1,1975, is not subject to the inpatient care limitation.