S.C. Medicaid Hospice Services Provider Manual § 4

In order for hospice services to be covered, they must be deemed reasonable and necessary for the

palliation or management of the terminal illness and related conditions. The individual must elect

hospice care in accordance with the provisions described under “Election Procedures.” A

certification that the individual is terminally ill must be completed as set forth under “Physician

Certification.” A POC must be established before services are provided; services rendered must be

consistent with the POC.

All services must be performed by appropriately qualified personnel, but it is the nature of the

service, rather than the qualification of the person who provides it, that determines the coverage

category of the service. The services below are covered hospice services:

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

• Medical social services provided by a social worker who has at least a bachelor’s degree and is

working under the direction of a physician.

• Physicians’ services provided by the hospice medical director or physician member of the

interdisciplinary group. Such services must be performed by a Doctor of Medicine or osteopathy.

The following services performed by hospice physicians are included in the hospice rates and

may not be billed as a physician’s service:

– General supervisory services performed by the medical director.

– Participation in the establishment of POC, supervision of care and services, periodic review and

updating of care plans and establishment of governing policies by the physician member of the

interdisciplinary group.

See “Payment for Physician Services” for additional information regarding the payment of physician

services not related to the above.

• Counseling services provided to the terminally ill individual and the family members or other

persons caring for the individual at home. Counseling, including dietary counseling, may be

provided both for the purpose of training the individual’s family or other caregiver to provide care

and for the purpose of helping the individual and those caring for him or her to adjust to the

individual’s approaching death.

• Short-term inpatient care provided in either a participating hospice inpatient unit or a

participating hospital or nursing home that additionally meets the special hospice standards

regarding staffing and patient areas. GIP care may be required for procedures necessary for

pain control or acute or chronic symptom management that cannot be provided in other settings.

Inpatient care may also be furnished to provide respite for the individual’s family or other

persons caring for the individual at home. Respite care is the only type of inpatient care that may

be provided in a nursing home.

• Medical appliances and supplies, including drugs and biologicals. Only drugs used primarily for

the relief of pain and symptom control related to the individual’s terminal illness are covered.

Appliances may include covered DME as well as other self-help and personal comfort items

related to the palliation or management of the patient’s terminal illness. Equipment is provided

by the hospice for use in the patient’s home while he or she is under hospice care. Medical

supplies include those that are part of the written POC.

• Home health aide services furnished by qualified aides. Home health aides may provide

personal care services. Aides also may perform household services to maintain a safe and

sanitary environment in areas of the home used by the patient, such as changing the bed or light

cleaning and laundering essential to the comfort and cleanliness of the patient. Aide services

must be provided under the general supervision of a registered nurse.

• Homemaker services, including assistance in personal care, maintenance of a safe and healthy

environment and services to enable the individual to carry out the POC.

• Physical therapy, occupational therapy and speech-language pathology services provided for

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

basic functional skills

NON- COVERED SERVICES

Respite care and continuous care are only reimbursed within certain limits. These are discussed in

detail under LOC.

Bereavement counseling consists of counseling services provided to the individual’s family after the

individual’s death. Bereavement counseling is a required hospice service, but is not reimbursable.