Wash. HCA Hospice Services Billing Guide, Definitions

This section defines terms and abbreviations, including acronyms, used in this

billing guide. Refer to chapter 182-500 WAC and WAC 182-551-1010 for a

complete list of definitions for Washington Apple Health.

Acute – Having a rapid onset, severe symptoms, and short course; not chronic.

Bereavement counseling – Counseling services provided to a client’s family or

significant others following the client’s death.

Brief period – Six days or less within a 30-consecutive-day period.

Certification statement – A document that states the client’s eligibility for each

election period and is:

• Created and filed by the Hospice agency for each HCA hospice client.

• Signed by the physician and/or hospice medical director.

Continuous home care – Services provided for a period of 8 or more hours in a

day. It may include homemaker services and home health aide services but must

be predominantly nursing care. It can be provided only during a period of acute

medical crisis or the sudden loss of a caregiver who was providing skilled nursing

care, and only as necessary to maintain the client at home. (HCA does not

reimburse for continuous home care provided to a client in a nursing facility,

hospice care center or hospital.)

Counseling – Services for the purpose of helping a client and those caring for

them to adjust to the individual’s approaching death. Other counseling (including

dietary counseling) may be provided for the purpose of educating or training the

client’s family members or other caregivers on issues related to the care and

needs of the client.

Developmental Disabilities Community Services (DDCS) - The division within

the Home and Community Living Administration under the Washington state

Department of Social and Health Services (DSHS) that assists children and adults

with developmental delays or disabilities, cognitive impairment, chronic illness,

and related functional disabilities.

DSHS – Department of Social and Health Services.

Election statement – A written document provided by the hospice agency that is

signed by the client to initiate hospice services.

General inpatient (GIP) hospice care - Acute care that includes services

administered to the client for acute pain and/or symptom management that

cannot be done in other settings. In addition:

• The services must conform to the client’s written plan of care (POC).

• This benefit is limited to brief periods of care delivered in HCA-approved:

o Hospitals.

o Nursing facilities.

o Hospice care centers.

Home - See Residence.

Home and Community Living Administration (HCLA) - The administration

within the Department of Social and Health Services (DSHS) that provides

services for adults needing long-term services and supports.

Home health aide – A person registered or certified as a nursing assistant under

chapter 18.88 RCW who, under the direction and supervision of a registered

nurse or licensed therapist, assists in the delivery of nursing or therapy related

activities, or both. (WAC 182-551-2010)

Home health aide services – Services provided by a home health aide only when

a client has an acute, intermittent, short-term need for the services of a registered

nurse, physical therapist, occupational therapist, or speech therapist who is

employed by or under contract with a home health agency. These services are

provided under the supervision of the previously identified authorized

practitioners and include, but are not limited to:

• Ambulation and exercise

• Assistance with self-administered medications

• Reporting changes in a client's condition and needs

• Completing appropriate records

Homemaker – A person who provides assistance in personal care, maintenance

of a safe and healthy environment, and services to enable a client’s plan of care

to be carried out.

Note: For the purposes of this billing guide, requirements for

hospice agencies also apply to hospice care centers.

Home and Community-Based Long-Term Services and Supports Program

(HCB LTSS) - A waiver or state plan program providing personal care services to

eligible individuals in the community. Examples include Community First Choice

(CFC), Roads to Community Living (RCL), Medicaid Personal Care (MPC), New

Freedom (NF), Residential Support Waiver, and DDCS Waiver.

Hospice daily rate - The dollar amount HCA will reimburse for each day of care.

Inpatient respite care - See Respite Care.

Intermittent – Stopping and starting again at intervals; pausing from time to

time; periodic.

Life-limiting condition - A medical condition in children that most often results

in death before adulthood.

Participation - The money a client owes before eligibility for Medicaid services.

Pediatric Palliative Care (PPC) - Palliative care for a child with a life-limiting

condition.

Referring provider – A client’s primary or general practitioner, or a physician or

nurse practitioner who has consulted with the client’s primary or general

practitioner.

Respite care – Short-term, inpatient care provided only on an intermittent, non-routine, and occasional basis and not provided consecutively for periods of

longer than six days in a 30-day period.

Routine home care – Intermittent care received by the client at the client’s place

of residence, with no restriction on length or frequency of visits, dependent on

the client’s needs.