Utah Medicaid Provider Manual, Hospice Care Services § 8

For additional information regarding hospice care services, see Utah

Administrative Code R414-14A-5. Hospice Care. Service Coverage or 42 CFR

418.64 Condition of Participation: Core Services. Specific coverage and

reimbursement information by procedure code is found in the Coverage and

Reimbursement Code Lookup.

Hospice agencies must provide the essential core services listed in this section.

Frequency of services must be based upon an individualized assessment of need

as determined by the attending qualified healthcare professional (QHP) and the

treatment team, and as specified in the plan of care. A hospice agency may use

contracted staff to supplement hospice employees during periods of peak

patient loads or other extraordinary circumstances. The hospice agency remains

responsible for the quality of services provided by contracted staff.

• The hospice medical director, physician employees, and contracted

physician(s) of the hospice, in conjunction with the patient’s attending

QHP, are responsible for the palliation and management of the terminal

illness and conditions related to the terminal illness.

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

• Medical social services provided by a qualified social worker under the

direction of a QHP.

• Administrative and general supervisory activities performed by QHPs who

are employees of, or working under arrangements made with, the hospice

agency.

• Counseling services for the individual and family members or other

persons caring for the person at home.

The following additional services must also be provided directly by, or made

available by, the hospice agency whenever it is deemed appropriate and

necessary by the treatment team and ordered by the attending QHP.

Bereavement counseling consists of counseling services provided to the

individual’s family after a member’s death. Bereavement counseling is a

required hospice service, but it is not reimbursable.

Special modalities: chemotherapy, radiation therapy, and other modalities may

be used if it is determined, by the member’s treatment team, that these services

are needed for palliation. This determination is based on the member’s

condition and the hospice agency’s caregiving philosophy. No additional

Medicaid payment will be made regardless of the cost of the services.