N.D. Medicaid Billing and Policy Manual, Hospice Services, Definitions

Attending physician – identified by the individual, at the time the member elects to

receive hospice care, as having the most significant role in the determination and

delivery of the individual's medical care and can be a:

• Doctor of medicine or osteopathy legally authorized to practice medicine and

surgery by the State in which he or she performs that function or action; or

• Nurse practitioner who meets the training, education, and experience

requirements as described in § 410.75(b) of this chapter; or

• Physician assistant who meets the requirements of § 410.74(c) of this chapter.

Bereavement counseling – emotional, psychosocial, and spiritual support and services

provided before and after the death of the patient to assist with issues related to grief,

loss, and adjustment.

BFCC-QIO – Beneficiary and Family Centered Care Quality Improvement Organization.

Cap period means the twelve-month period ending September 30 used in the

application of the cap on overall hospice reimbursement specified in § 418.309.

Clinical note – a notation of a contact with the patient and/or the family that is written

and dated by any person providing services and that describes signs and symptoms,

treatments and medications administered, including the patient's reaction and/or

response, and any changes in physical, emotional, psychosocial or spiritual condition

during a given period of time.

Comprehensive assessment – a thorough evaluation of the patient's physical,

psychosocial, emotional and spiritual status related to the terminal illness and related

conditions. This includes a thorough evaluation of the caregiver's and family's

willingness and capability to care for the patient.

Dietary counseling – education and interventions provided to the patient and family

regarding appropriate nutritional intake as the patient's condition progresses. Dietary

counseling is provided by qualified individuals, which may include a registered nurse,

dietitian or nutritionist, when identified in the patient's plan of care.

Employee – a person who:

• Works for the hospice and for whom the hospice is required to issue a W-2 form

on his or her behalf;

• If the hospice is a subdivision of an agency or organization, an employee of the

agency or organization who is assigned to the hospice; or

• Is a volunteer under the jurisdiction of the hospice.

Hospice – a public agency or private organization or subdivision of either of these that is

primarily engaged in providing hospice care as defined in this section.

Hospice care – a comprehensive set of services described in 1861(dd)(1) of the Act,

identified and coordinated by an interdisciplinary group to provide for the physical,

psychosocial, spiritual, and emotional needs of a terminally ill patient and/or family

members, as delineated in a specific patient plan of care.

Initial assessment – an evaluation of the patient's physical, psychosocial and emotional

status related to the terminal illness and related conditions to determine the patient's

immediate care and support needs.

Licensed professional – a person licensed to provide patient care services by the State

in which services are delivered.

Multiple location – a Medicare-approved location from which the hospice provides the

same full range of hospice care and services that is required of the hospice issued the

certification number. A multiple location must meet all of the conditions of participation

applicable to hospices.

Palliative care – a patient and family-centered care that optimizes quality of life by

anticipating, preventing, and treating suffering. Palliative care throughout the continuum

of illness involves addressing physical, intellectual, emotional, social, and spiritual

needs and to facilitate patient autonomy, access to information, and choice.

Physician – an individual who meets the qualifications and conditions as defined in

section 1861(r) of the Act and implemented at § 410.20 of this chapter.

Physician designee – a doctor of medicine or osteopathy designated by the hospice

who assumes the same responsibilities and obligations as the medical director when

the medical director is not available.

Pseudo-patient – a person trained to participate in a role-play situation, or a computer-based mannequin device. A pseudo-patient must be capable of responding to and

interacting with the hospice aide trainee and must demonstrate the general

characteristics of the primary patient population served by the hospice in key areas

such as age, frailty, functional status, cognitive status and care goals.

Representative – an individual who has the authority under State law (whether by

statute or pursuant to an appointment by the courts of the State) to authorize or

terminate medical care or to elect or revoke the election of hospice care on behalf of a

terminally ill patient who is mentally or physically incapacitated. This may include a legal

guardian.

Restraint – any manual method, physical or mechanical device, material, or equipment

that immobilizes or reduces the ability of a patient to move his or her arms, legs, body,

or head freely, not including devices, such as orthopedically prescribed devices,

surgical dressings or bandages, protective helmets, or other methods that involve the

physical holding of a patient for the purpose of:

• Conducting routine physical examinations or tests or to protect the patient from

falling out of bed, or

• To permit the patient to participate in activities without the risk of physical harm

(this does not include a physical escort); or

• A drug or medication when it is used as a restriction to manage the patient's

behavior or restrict the patient's freedom of movement and is not a standard

treatment or dosage for the patient's condition.

Seclusion – the involuntary confinement of a patient alone in a room or an area from

which the patient is physically prevented from leaving.

Simulation – a training and assessment technique that mimics the reality of the

homecare environment, including environmental distractions and constraints that evoke

or replicate substantial aspects of the real world in a fully interactive fashion, in order to

teach and assess proficiency in performing skills, and to promote decision making and

critical thinking.

Terminally ill – that the individual has a medical prognosis that his or her life expectancy

is 6 months or less if the illness runs its normal course.