Utah Medicaid Provider Manual, Hospice Care Services § 8-1

Attending qualified healthcare professional (QHP): a physician, physician

assistant, or nurse practitioner as defined in the Section I: General Information

provider manual who:

• Meets proper training, education, and experience requirements within

their scope of licensing, and

• Is identified by the member, when they elect to receive hospice care, as

having the most significant role in determining and delivering the

member’s medical care.

Adult: a member who is 21 years of age or older.

Cap period: the 12-month period, ending September 30, used in the application

of the cap on overall hospice reimbursement specified in 42 CFR 418.309.

Concurrent care: a pediatric member, receiving hospice care, may also continue

to receive curative treatment.

Continuous home care day: a day in which a member, who has elected to

receive hospice care at home, receives a minimum of 8 aggregate hours of care

from the hospice agency during a 24-hour day, which begins and ends at

midnight. The 8 hours of care must be predominately nursing care provided by

either a registered nurse or a licensed practical nurse.

Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT):

a federally mandated program that provides comprehensive and preventive

health care services for children age birth through 20 years who are enrolled in

Traditional Medicaid.

General inpatient care day: a day when a member with elected hospice care

receives general inpatient care for pain control or acute or chronic symptom

management that is not manageable in their place of residence or another

outpatient setting.

Hospice agency: an agency licensed under the provisions of Rule R432-750 and

is primarily engaged in providing hospice care to terminally ill individuals.

Hospice care services: an approach to caring for terminally ill members that

stresses palliative care as opposed to curative care. In addition to meeting the

member’s medical needs, hospice care services address the physical,

psychosocial, and spiritual needs of the member, as well as the psychosocial

needs of the member’s family/caregiver. The emphasis of hospice care services

is on keeping the member at home with family and friends as long as possible.

Inpatient respite care day: a day when a member with elected hospice care

receives short-term inpatient care necessary to relieve family members or other

persons caring for the member at their place of residence.

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

anticipating, preventing, and treating suffering. Palliative care addresses

physical, intellectual, emotional, social, and spiritual needs while facilitating

patient autonomy, access to information, and choice.

Pediatric: a member who is under 21 years of age.

Pediatric hospice agency: an enrolled hospice agency that has trained

employees in providing hospice care to patients who are younger than 21 years

of age.

Representative: an individual who has been authorized under state law to

make health care decisions on behalf of the member, including initiating,

continuing, refusing, or terminating medical treatments for a member who

cannot make the decisions for themselves.

Terminally ill: a medical prognosis to live no more than 6 months if the illness

runs its ordinary course.