Vt. Medicaid Hospice Provider Manual § 4

Attending Physician

A Doctor of Medicine or osteopathy legally authorized to practice medicine and surgery by the

State, a nurse practitioner who meets the training, education, and experience requirements as

described in 42 CFR § 410.75(b), or a physician assistant who meets the requirements of 42 CFR

§ 410.74(c) who is identified by the member at the time of election of hospice services as having

the most significant role in the determination and delivery of the member’s medical care.

Bereavement Counseling

Emotional, psychosocial, and spiritual support and services provided before and after the death of

the member to assist with issues related to grief, loss, and adjustment.

Certification Of Terminal Illness

A statement signed by the physician certifying that the member has a medical prognosis with a life

expectancy of six months or less if the illness runs its normal course.

Dual-Eligible Member

Dual eligible members are divided into two groups:

• Ful

l benefit duals: These members have both Medicare and Medicaid.

• Partial duals: These members have Medicare and qualify for a Medicare Savings Plan

(MSP).

Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT)

EPSDT is a federally mandated benefit for all Vermont Medicaid eligible children under age 21.

EPSDT services include periodic screenings to identify physical and mental conditions, vision,

hearing, dental problems and follow-up diagnostic and treatment services, and assistance with

transportation to medical appointments. It requires the state to provide any health care service

that is medically necessary, even if the service is not covered for adults. For hospice care this

includes coverage of curative care to treat a terminal illness. Services are covered according to

Health Care Administrative Rules (HCAR) 4.106.

Election Period

One of three or more periods of care for which a member may elect to receive hospice services.

Election periods consist of an initial 90-day period, a subsequent 90-day period, and an unlimited

number of subsequent 60-day periods.

Hospice Agency

An entity administering or providing hospice services directly or through a contract arrangement

for clients in places of temporary or permanent residence under the direction of an interdisciplinary

team composed of at least a nurse, social worker, physician, spiritual counselor, and volunteer.

Hospice Care

A comprehensive, holistic program of care and support for terminally ill patients and their families.

Hospice care focuses on comfort care and quality of life instead of care to cure the patient’s

illness.

Hospice Interdisciplinary Team (IDT)

The interdisciplinary team of professionals who support the physical, medical, psychosocial,

emotional, and spiritual needs of both the hospice member and the hospice member’s family.

Hospice Provider

A Medicaid enrolled public agency or private organization that is primarily engaged in providing

pain relief (palliative care), respite care, symptom management, and supportive services to

terminally ill people and their families. Hospice providers must be Medicare-certified and deliver

services according to Medicare conditions of participation.

Licensed Professional

A Medicaid enrolled provider licensed to practice medicine within the scope of their profession to

provide patient-care services in Vermont.

Levels of Care:

• Continuous Home Care - a day when both of these apply:

o The patient gets hospice care in a home setting that isn’t an inpatient facility

(hospital, SNF, or hospice inpatient unit) AND,

o The care consists mainly of nursing care on a continuous basis at home.

o Patients can also get hospice aide, homemaker services, or both on a continuous

basis. Hospice patients can get continuous home care only during brief periods of

crisis and only as needed to maintain the patient at home.

• Routine Home Care - a day the patient elects to get hospice care at home and isn’t getting

continuous home care. A patient’s home might be a home, a skilled nursing facility (SNF),

or an assisted living facility. Routine home care is the level of care provided when the

patient isn’t in crisis.

• Inpatient General Care - a day the patient elects hospice care in an inpatient facility for pain

control or acute or chronic symptom management, which can’t be managed in other

settings.

• Inpatient Respite Care - a day the patient elects to get hospice care in an approved

inpatient facility for up to 5 consecutive days to give their caregiver a rest.

Nursing Facility

A facility that meets all criteria and certification requirements.

Terminal Illness

A condition in which the member has a medical prognosis of a life expectancy of six months or

less if the illness runs its normal course.