N.C. Medicaid Clinical Coverage Policy No. 3D § 7.3.2

The provider of hospice services shall comply with:

42 CFR §418.112 Condition of participation: Hospices that provide hospice care

to residents of a SNF/NF or ICF/IID; 42 CFR §418.100 Condition of

Participation: Organization and administration of services; and 42 CFR §418.108

Condition of participation: Short-term inpatient care.

The hospice provider shall assume professional management of the beneficiary's

hospice services provided, in accordance with the hospice plan of care and the

hospice conditions of participation, and make any arrangements necessary for

hospice-related inpatient care in a participating Medicaid facility according to 42

CFR §418.100 and 42 CFR §418.108.

The hospice provider shall assess and coordinate the beneficiary’s hospice and

medical care to facilitate continuity of the care and the facility agrees to provide

room and board to the beneficiary.

The agreement must include the following provisions:

a. Coordination of services in accordance with the plan of care developed by the

IDG and indication of the services to be provided by the facility and the

services to be provided by the hospice staff;

b. Indication of the financial arrangements involved, as well as the rate of

reimbursement to the nursing facility and the collection of any Patient

Monthly Liability (PML) amounts;

c. The agreement by the facility to provide room and board and related services.

Room and board services are:

1. the performance of personal care services;

2. assistance in activities of daily living;

3. socializing activities;

4. administration of medication;

5. maintaining the cleanliness of a resident’s room;

6. supervising and assisting in the use of DME and prescribed therapies; and

7. all the requirements and services outlined in clinical coverage policy 2B1,

Nursing Facilities, on NC Medicaid’s website at

https://medicaid.ncdhhs.gov/.

d.

A hospice provider shall have the responsibility of providing the medications

directly related to the terminal illness; a DME provider shall have the

responsibility of providing the medical equipment directly related to the

terminal illness;

e.

All other details related to the provision of care and compliance with current

North Carolina Rules Governing the Licensure of Hospice;

f.

Process and responsibility for changes to the plan of care. The hospice

provider is responsible for approving changes to the plan of care. The hospice

shall provide a copy of the plan of care for the facility, and the facility shall

allow the hospice access to documentation on the beneficiary’s care; and

g.

Hospice provider responsibility for monitoring the care provided to ensure

the adequacy of the care provision and to determine the need for any changes.