Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 437.000 - Hospice Services › Section 437.424 - Covered Services

Current through Register 1525, July 5, 2024
The hospice provider must provide services for the palliation
				and management of the terminal illness and related conditions. All services
				must be performed by appropriately qualified personnel, but the nature of the
				service, rather than the qualifications of the person who provides it,
				determines the reimbursement category of the service, as defined in
				130
				CMR 437.424. The following services are
				covered hospice services.
(A)
Nursing Services
. The hospice must provide nursing
			 care and services by or under the supervision of a nurse. Nursing services must
			 ensure that the nursing needs of the member are met as identified in the
			 member's initial assessment, comprehensive assessment, and any updated
			 comprehensive assessments. The hospice provider is responsible for providing
			 all routine nursing care that can be completed during a standard nursing visit,
			 including the collection of vital signs and treatment of minor injuries or
			 sores, and all such routine nursing care must be completed by the hospice nurse
			 unless the member resides in a nursing facility or ICF/IID and provision of
			 certain routine nursing care is appropriately coordinated with the nursing
			 facility or ICF/IID in accordance with
			 42 CFR
			 418.112.
(B)
Medical Social
			 Services
. Medical social services must be provided by a qualified
			 social worker under the direction of a physician. The social worker is
			 responsible for analyzing and assessing social and emotional factors and the
			 member's capacity to cope with them, helping the member and the member's family
			 follow hospice recommendations, and assisting the member's family with personal
			 and environmental difficulties and in using community resources.
(C)
Physician
			 Services
. In addition to palliation and management of terminal
			 illness and related conditions, physicians employed by or under contract with
			 the hospice provider, including the physician member of the hospice
			 interdisciplinary team, must also meet the general medical needs of the members
			 to the extent that these needs are not met by the member's attending physician.
			 Physicians may bill MassHealth for services not related to the terminal illness
			 according to MassHealth physician regulations at
			 130 CMR
			 433.000:
Physician
			 Services.
(D)
Counseling Services
. The following counseling services
			 must be available to the member and member's family or other persons caring for
			 the member at home.
(1)
Bereavement Counseling
. An organized plan of care for
			 bereavement counseling must be developed by a qualified professional under the
			 auspices of the hospice provider. This plan of care must reflect family needs,
			 delineate the services to be provided, and specify the frequency of service
			 delivery. Bereavement counseling is a required hospice service, but is not
			 reimbursable.
(2)
Dietary Counseling
. When needed, dietary counseling
			 services must be provided by a qualified professional.
(3)
Spiritual
			 Counseling
. The hospice must:
(a)
			 Provide an assessment of the member's and family's spiritual needs.
(b) Provide spiritual counseling to meet
			 these needs in accordance with the member's and family's acceptance of this
			 service, and in a manner consistent with the member and family beliefs and
			 desires.
(c) Make all reasonable
			 efforts to facilitate visits by local clergy, pastoral counselors, or other
			 individuals who can support the member's spiritual needs
(4)
Additional
			 Counseling
. Additional counseling may be provided by other members
			 of the hospice interdisciplinary team as well as by other qualified
			 professionals as determined by the hospice provider.