W. Va. BMS Provider Manual ch. 509, Glossary

Definitions in the BMS Manual Chapter 200, Definitions and Acronyms apply to all West Virginia Medicaid

services, including those covered by this chapter. Definitions in this glossary are specific to this chapter.

Attending Physician: In accordance with 42 CFR §418.3(1)(i), a doctor of medicine or osteopathy legally

authorized to practice medicine and surgery by the State in which he or she performs that function or

action.

Nurse Practitioner (NP): A nurse who meets the training, education and experience requirements as

described in §410.75(b). (2) Is identified by the member, at the time he or she elects to receive Hospice

care, 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 (see 42 CFR

§418.3).

Employee: A person (including contractors and volunteers who works for the Hospice and for whom the

Hospice is required to issue a W-2 form on his or her behalf; if the Hospice is a subdivision of an agency

or organization, an employee of the agency or organization who is assigned to the Hospice; or is a

volunteer under the jurisdiction of the Hospice (in accordance with 42 CFR §418.3).

Hospice Aide (formally referred to as Home Health Aide): A person specially trained to assist sick,

disabled, infirm, or frail persons at home when no family member is fully able to assume this

responsibility. Aides are supervised by health professionals, and provided as part of a continuing medical

care plan in accordance with the West Virginia State Plan on Hospice services.

Homemaker Aide: A person specially trained to provide direct care and support services that are

necessary in order to enable a member to remain at home rather than enter a nursing facility, or to enable

an individual to return home from a nursing facility. Homemaker services include assistance with personal

hygiene, nutritional support, and environment maintenance. These aides are supervised by health

professionals and provided as part of a continuing medical care plan in accordance with the West Virginia

State Plan on Hospice Services.

Hospice Care: A comprehensive set of services described in 1861(dd)(1) of the Social Security Act,

identified and coordinated by an interdisciplinary group to provide for the physical, psychosocial, spiritual,

and emotional needs of a terminally ill member and/or family members, as delineated in a specific patient

plan of care (see 42 CFR §418.3).

Hospice Discharge: A Hospice provider determines that the patient is no longer terminally ill, expires,

moves out of the Hospice’s service area, transfers to another Hospice, or the patient (or other persons in

the patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to

the patient or the ability of the Hospice to operate effectively is seriously impaired (in accordance with 42

CFR §418.26).

Hospice Informed Consent: A written agreement to receive Hospice care made by the member or

representative that specifies in writing the type of care and services to be provided. The informed consent

form shall be signed by the member or the member’s legal representative prior to service.

Hospice Interdisciplinary Team (IDT): An IDT of professionals comprised at minimum, of a physician, a

social worker, and nurse who plan and direct the care of each Hospice member, along with home health

aides and counseling/clergy persons who provide additional services (in accordance with 42 CFR

§418.56).

Interdisciplinary Team Plan of Care: A group of interdisciplinary professionals (physician, nurse, social

worker, counselor/clergy) that collaborates continuously with the member’s attending physician (if the

member has an attending physician) to develop and maintain a member-directed, individualized plan of

care. The plan is based on the interdisciplinary team assessments which recognize the member and

family’s physiological, social, religious, and cultural variables and value (in accordance with 42 CFR

§418.56).

Palliative Care: Member and family-centered care that optimizes quality of life by anticipating,

preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing

physical, intellectual, emotional, social, and spiritual needs and to facilitate member autonomy, access to

information, and choice (see 42 CFR §418.3).

Physician Designee: A Doctor of Medicine or Osteopathy designated by the Hospice who assumes the

same responsibilities and obligations as the medical director when the medical director is not available.

(See 42 CFR §418.3).

Pre-Existing Conditions: The health status existing prior to the diagnosis of the terminal illness arising in

organs that are not typically affected by the terminal illness.

Related Condition: A medical condition that arises as a direct logical consequence of the terminal

illness.

Revocation: To cancel or withdraw the election of Hospice care (in accordance with 42 CFR §418.28).

Terminally ill: A medical prognosis that the patient’s life expectancy is 6 months or less if the illness runs

its normal course (see 42 CFR §418.3).

Transfer: Changing the Hospice provider from which a member is receiving services to another Hospice

provider.