N.H. Medicaid Hospice Provider Manual, Vol. II, § 3, Covered Services

The designated hospice provider shall create a plan of care for the member in accordance with 42

CFR 418.56 a.2.(b) that specifies the services to be provided to the member, which are reasonable and

necessary for the palliation or management of the symptoms of the terminal illness and conditions or

complications related to the terminal illness.

Pursuant to He-W 544, services covered as part of the hospice benefit include:

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Nursing care provided by or under the supervision of a registered nurse;

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Medical social services provided by a social worker who has at least a bachelor’s degree from

a school accredited or approved by the Council on Social Work Education, and who is

working under the direction of a physician;

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Counseling services, including dietary counseling, provided to the member, family members,

and others caring for the member for the purpose of training the member’s family or

caregivers to provide care;

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Durable medical equipment and supplies for self-help and personal comfort related to the

palliation or management of the member’s terminal illness or conditions related to the

terminal illness while the member is under hospice care;

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Drugs for the palliation and management of the member’s terminal illness or conditions

related to the terminal illness;

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Home health aide and homemaker services;

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Physical therapy, occupational therapy, and speech language pathology services for the

purpose of symptom control or to enable the member to maintain activities of daily living and

basic functional skills;

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Ambulance and wheelchair van transportation;

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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;

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Services performed by a hospice physician as follows:

o General supervisory services of the medical director;

o Participation in the establishment of plans of care, supervision of care and services,

periodic review and updating of plans of care, and establishment of governing

policies by the physician member of the interdisciplinary group; and

o Physician services that are related to the treatment of the terminal illness (such

services are part of the per diem rate);

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General inpatient care, which is hospice care provided in an inpatient facility for pain control

or symptom management and that cannot be managed in an outpatient setting, provided as

follows:

o The care is provided in a NH Medicaid enrolled hospice house, licensed in

accordance with RSA 151 and He-P 824, a hospital, or a nursing facility that meets

the requirements in 42 CFR 418.110 regarding staffing and patient areas;

o Federal hospice regulations at 42 CFR 418.110 for inpatient care specify the

conditions of participation (COP) for general inpatient care and should be reviewed

in their entirety;

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Continuous home care to maintain the member at home as follows:

o The care is provided only during a period of crisis, which is a period during

which the member requires continuous care to achieve palliation or management

of acute medical symptoms;

o The continuous home care must be for a minimum of eight hours of care during a

24-hour day, which need not be consecutive hours. The 24-hour day begins at

midnight and ends at 11:59 p.m.;

o The continuous care is primarily nursing care with more than half of the eight

hours of the period of care being provided by a registered nurse (RN) or licensed

practical nurse (LPN). Home health aides may supplement the nursing care in

the total continuous care hours; and

o The hospice provider must maintain documentation that clearly indicates the

nature of the medical crisis and the need for skilled intervention, including the

level of staffing and the services that were provided both hourly and daily.

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Inpatient Respite Care which is short-term inpatient care provided to a member who does not

reside in a nursing facility, and is used only when necessary to relieve the family members or

other persons caring for the member when provided as follows:

o Inpatient Respite Care cannot be used for more than one period of 5 consecutive

days at a time per election period, except that the sixth and any subsequent

consecutive days shall be covered and paid at the routine home care rate.

o Inpatient respite hospice care may only be provided in intermediate care facilities

that meet the requirements of 42 CFR 418.100 (a) and (e) regarding 24-hour

nursing and patient areas.

The member’s plan of care shall include bereavement counseling for the member’s family after the

member’s death. Bereavement counseling shall not be billable to NH Medicaid nor to the member’s

family.

Pursuant to He-W 544, a member is not required to waive rights to the following services, which shall be

covered in addition to hospice services:

1. Services provided by the member’s NH Medicaid attending physician if that physician is

not an employee of the designated hospice, or is not receiving compensation from the hospice

for those services; and

2. Room and board services provided by a nursing facility if the member meets nursing

facility level of care.