Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-43 - Hospice Services › Subsection 144-101-II-43.05 - COVERED SERVICES

Current through 2024-29, July 17, 2024
43.05-1
Covered Services
Covered hospice services must be reasonable and necessary
						for the palliation or management of the terminal illness and related
						conditions. To be covered, all services must be in accordance with the plan of
						care and approved by the Interdisciplinary Team. Services unrelated to the
						terminal illness which affect the plan of care must be reflected in the plan in
						order to assure coordination and non-duplication of services.
The following are considered covered hospice services.
						Unless noted otherwise, reimbursement shall be based on a per diem or hourly
						rate, and in accordance with the provisions described in Section
						43.07.
A. Physician Services (see Section
					 43.07-3 for further
					 details).
B. Nursing Services
					 provided by or under the supervision of a registered nurse.
C. Medical Social Services provided by a
					 medical social worker working under the supervision of a physician.
D. Counseling Services must be available to
					 the member and family members or others caring for the member at home,
					 including dietary, spiritual and other counseling. Counseling may be given both
					 for the purpose of training caregivers to provide care, and for the purpose of
					 helping the member and those caring for him or her to adjust to the member's
					 approaching death.
E. Home Health
					 Aide Services furnished by certified home health aides and certified nursing
					 assistants. Home health aides may provide personal care and household services
					 essential to the comfort and cleanliness of the member and maintaining a safe
					 and healthy environment to allow implementation of the plan of care. Aide
					 services must be provided under the general supervision of a registered nurse.
Home health aide services can include the provision of
						homemaker services. Homemaker services include maintenance of a safe and
						healthy environment and services that enable the member to carry out the plan
						of care.
F. Medical
					 Supplies, Drugs and Biologicals are covered only when used primarily for the
					 relief of pain and symptom control related to the member's terminal illness.
					 Appliances may include covered durable medical equipment as well as other
					 self-help and personal comfort items related to relief or management of the
					 terminal illness. Equipment is provided by the hospice for use in the member's
					 home while under hospice care. Medical supplies include those that are part of
					 the written plan of care.
G.
					 Short-Term Inpatient Care provided in a participating hospice inpatient unit or
					 a participating hospital or nursing facility which meets the special hospice
					 standards regarding staffing and patient areas. Participating facilities are
					 defined as those with which the hospice has a contract that provides for all
					 requirements contained within the Medicare Hospice conditions of participation.
					 Inpatient services 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 individuals caring for the
					 member at home.
H. Physical,
					 Occupational and Speech/Language Therapy provided for symptom control or to
					 allow the member to perform daily living activities and basic functional
					 skills.
I. Special Modalities,
					 including chemotherapy, radiation therapy, and other modalities that may be
					 used for palliative purposes if it is determined that these services are needed
					 for palliation. This determination is based on the member's condition and
					 philosophy of care giving of the hospice. No additional MaineCare reimbursement
					 shall be provided, regardless of the cost of the services.
J. Ambulance Services, when the medical
					 condition requiring ambulance transport is a result of the member's terminal
					 illness.
K. Other Items and
					 Services specified in the plan of care for which payment may otherwise be made.
					 This item reflects the hospice's responsibility for providing any and all
					 services in the plan of care necessary for the relief and management of the
					 terminal illness and related conditions.