Wash. HCA Hospice Services Billing Guide, What is included in the hospice daily rate?

HCA reimburses a hospice agency for providing covered services through HCA’s

hospice daily rate. The hospice daily rate includes core services and supplies.

These are subject to the conditions and limitations described in this billing guide.

For reimbursement of covered services, including core services and supplies that

are included in the hospice daily rate, the service must be:

• Related to the client’s hospice diagnosis.

• Identified by a client’s hospice interdisciplinary team.

• Written in the client’s plan of care (POC).

• Safe and meet the client’s needs within the limits of the Hospice program.

• Available to the client by the hospice agency on a 24-hour basis.

Note: Services are intermittent except during brief periods of

acute symptom control. The client/family has 24-hour access to a

registered nurse (RN)/physician.

The hospice daily rate includes the following core services that must either be:

• Provided by hospice agency staff

-OR-

• Contracted through a hospice agency, if necessary, to supplement hospice

staff in order to meet the needs of a client during a period of peak patient

loads or under extraordinary circumstances including:

o Physician services related to administration of the POC.

o Nursing care provided by:

▪ A registered nurse (RN).

▪ A licensed practical nurse (LPN) under the supervision of an RN.

o Medical social services provided by a social worker under the direction of a

physician.

o Counseling services provided to a client and the client’s family members or

caregivers.

Covered services and supplies must be provided by a service organization or an

individual provider when contracted through a hospice agency. To be reimbursed

the hospice daily rate, a hospice agency must:

• Ensure all contracted staff meets the regulatory qualification requirements.

• Have a written agreement with the service organization or individual provider

providing the services and supplies.

• Maintain professional, financial, and administrative responsibility.

Note: Personal care is not a core service. A home health aide

from a hospice agency that is needed under the client’s plan of

care (POC) is different than personal care from a caregiver.

Record in the client’s record what services the hospice agency is

providing and what Long-Term Services and Supports (LTSS) or

personal care services are being provided by others. Document

the frequency and services of both to show non-duplication.

Subject to the limitations described in this guide, the following covered services

and supplies, as described in Hospice Reimbursement, are included in the

appropriate hospice daily rate:

• A brief period of inpatient care, for general or respite care provided in a

Medicare-certified hospice care center, hospital, or nursing facility

• Adult day health

• Communication with non-hospice providers about care not related to the

client’s terminal illness to ensure the client’s POC needs are met and not

compromised

• Coordination of care, including coordination of medically necessary care not

related to the client’s terminal illness

• Drugs, biologicals, and over-the-counter medications used for the relief of

pain and symptom control of a client’s terminal illness and related conditions

Note: The provider of the drugs and biologicals bills HCA

separately for enteral/parenteral supplies only when there is a

pre-existing diagnosis requiring enteral/parenteral support. This

pre-existing diagnosis must not be related to the diagnosis that

qualifies the client for hospice.

• Hospice aide services that are ordered by a client’s physician and

documented in the POC. (Hospice aide services are provided through the

hospice agency to meet a client’s extensive need due to the client’s terminal

illness.) These services must be provided by a qualified home health aide and

are an extension of skilled nursing or therapy services. (See 42 CFR § 484.36)

• Interpreter services as necessary for the POC

• Durable medical equipment and related supplies, prosthetics, orthotics,

medical supplies, related services, or related repairs and labor charges

that are medically necessary for the palliation and management of a client’s

terminal illness and related conditions

• Medical transportation services, including ambulance as required by POC

related to the terminal illness (see WAC 182-546-5550)

• Physical therapy, occupational therapy, and speech-language therapy to

manage symptoms or enable the client to safely perform activities of daily

living (ADLs) and basic functional skills

• Skilled nursing care

• Other services or supplies that are documented as necessary for the

palliation and management of the client’s terminal illness and related

conditions

The hospice agency is responsible for determining if a nursing facility has

requested authorization for medical supplies or medical equipment, including

wheelchairs, for a client who becomes eligible for the Hospice program. HCA

does not pay separately for medical equipment or supplies that were previously

authorized by HCA and delivered on or after the date HCA enrolls the client in

hospice.

Note: If the covered services listed above are not documented in

the POC but are considered necessary by medical review for

palliative care and are related to the hospice diagnosis, the

hospice agency is responsible for payment.