Idaho Administrative Code › Title IDAPA 16 - Health and Welfare, Department of › Rule 16.03.10 - MEDICAID ENHANCED PLAN BENEFITS › SUB AREA: HOSPICE › Section 16.03.10.453 - HOSPICE: COVERAGE REQUIREMENTS AND LIMITATIONS

Current through August 31, 2023
The following services are required: (3-17-22)
01.
Nursing Care
. Nursing care
				provided by or under the supervision of a licensed registered nurse.
				(3-17-22)
02.
Medical Social
				Services
. Medical social services provided by a social worker who has at
				least a bachelor's degree from a school accredited or approved by the Council
				on Social Work Education, and who is working under the direction of a
				physician. (3-17-22)
03.
Physician Services
. Physician's services performed by a physician as
				defined in Subsection
				451.01 of these rules.
				(3-17-22)
04.
Counseling
				Services
. Counseling services provided to the terminally ill participant
				and the family members or other persons caring for the participant at home.
				Counseling, including bereavement and dietary counseling, are core hospice
				services provided both for the purpose of training the participant's family or
				other caregiver to provide care, and for the purpose of helping the participant
				and those caring for them to adjust to the participant's approaching death.
				(3-17-22)
05.
Inpatient
				Care
. Short-term inpatient care provided in a participating hospice
				inpatient unit, or a participating hospital, or a nursing facility that
				additionally meets the hospice standards regarding staff and patient areas.
				Services provided in an inpatient setting must conform to the written plan of
				care. General inpatient care may be required for procedures necessary for pain
				control or acute or chronic symptom management that cannot be provided in other
				settings. Inpatient care may also be furnished to provide respite for the
				participant's family or other persons caring for the participant at home.
				(3-17-22)
06.
Medical
				Equipment and Supplies
. Medical equipment and supplies include drugs and
				biologicals. Only drugs as defined in Subsection
				1861(t)  of the
				Social Security Act and that are used primarily for the relief of pain and
				symptom control related to the patient's terminal illness are required.
				Appliances include durable medical equipment as well as other self-help and
				personal comfort items related to the palliation or management of the patient's
				terminal illness. Equipment is provided by the hospice for use in the patient's
				home while they are under hospice care. Medical supplies include only those
				that are part of the written plan of care. (3-17-22)
07.
Home Health Services
. Home
				health aide and homemaker services furnished by qualified aides. Home health
				aides will provide personal care services and will also perform household
				services necessary to maintain a safe and sanitary environment in areas of the
				home used by the patient. Aide services must be provided under the general
				supervision of a licensed registered nurse. Homemaker services include
				assistance in maintenance of a safe and healthy environment and services to
				enable the participant to carry out the plan of care. (3-17-22)
08.
Therapies
. Physical therapy,
				occupational therapy and speech-language pathology services provided for
				purposes of symptom control or to enable the participant to maintain activities
				of daily living and basic functional skills. (3-17-22)
09.
Core Services
. Nursing care,
				physician's services, medical social services, and counseling are core hospice
				services and must be routinely provided by hospice employees. Supplemental core
				services may be contracted for during periods of peak patient loads and to
				obtain physician specialty services. (3-17-22)