Louisiana Administrative Code › Title 50 - PUBLIC HEALTH-MEDICAL ASSISTANCE › Part XV - Services for Special Populations › Subpart 3 - Hospice › Chapter 39 - Covered Services › Section XV-3901 - Medical and Support Services

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Hospice is a package of medical and support services for the terminally ill
				  individual. The following services are covered hospice services.
1. Nursing care provided by or under the
				  supervision of a registered nurse.
2. Medical social services provided by a
				  social worker who has at least a masters degree from a school of social work
				  accredited by the Council on Social Work Education, and who is working under
				  the direction of a physician.
3.
				  Physicians' services performed by a physician (as defined in
				  42 CFR
				  410.20). In addition to palliation and
				  management of the terminal illness and related conditions, physician employees
				  of the hospice and physicians under contract to the hospice, including the
				  physician member(s) of the interdisciplinary group, must also meet the general
				  medical needs of the patients to the extent that these needs are not met by the
				  attending physician. The medical director of the hospice is to assume overall
				  responsibility for the medical component of the hospice's patient care
				  program.
4. Counseling services
				  must be available to the terminally ill individual and the family members or
				  other persons caring for the individual at home. Counseling, including dietary
				  counseling, may be provided both for the purpose of training the individual's
				  family or other care -giver to provide care, and for the purpose of helping the
				  individual and those caring for him or her to adjust to the individual's
				  approaching death. Counseling includes bereavement counseling, provided after
				  the patient's death as well as dietary, spiritual and any other counseling
				  services for the individual and family provided while the individual is
				  enrolled in the hospice.
a. There must be an
				  organized program for the provision of bereavement services under the
				  supervision of a qualified professional. The plan of care for these services
				  should reflect family needs, as well as a clear delineation of services to be
				  provided and the frequency of service delivery (up to one year following the
				  death of the patient).
i. Bereavement
				  counseling is a required hospice service but it is not reimbursable.
b. Dietary counseling, when
				  required, must be provided by a qualified individual.
c. The hospice must make reasonable efforts
				  to arrange for visits of clergy and other members of religious organizations in
				  the commu nity to patients who request such visits and must advise patients of
				  this opportunity.
d. Additional
				  counseling may be provided by other members of the interdisciplinary group as
				  well as by other qualified professionals as determined by the
				  hospice.
5. Short-term
				  inpatient care provided in a participating hospice inpatient unit, or a
				  participating hospital or nursing facility that additionally meets the special
				  hospice standards regarding staffing 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 which cannot be provided in other settings.
				  Inpatient care may also be furnished to provide respite for the individual's
				  family or other persons caring for the individual at home.
6. Medical appliances and supplies, including
				  drugs and biologicals. Only drugs as defined in '1861(t) of the Social Security
				  Act and which are used primarily for the re lief of pain and symptom control
				  related to the individual's terminal illness are covered. Appliances may
				  include covered 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 he or she is under hospice care. Medical supplies include those that
				  are part of the written plan of care.
a. The
				  hospice must have a policy for the disposal of controlled drugs maintained in
				  the patient's home when those drugs are no longer needed by the
				  patient.
b. Drugs and biologicals
				  shall be administered only by a licensed nurse or physician, an employee who
				  has completed a state-approved training program in medication administration,
				  the patient if his or her attending physician has approved, or any other
				  individual in accordance with applicable state and local laws. The persons and
				  each drug and biological they are authorized to administer must be specified in
				  the patient's plan of care.
7. Home Health Aide Services Furnished by
				  Qualified Aides and Homemaker Services. Home health aides may provide personal
				  care services. Aides may also perform household services to maintain a safe and
				  sanitary environment in areas of the home used by the patient, such as changing
				  the bed or light cleaning and laundering essential to the comfort and
				  cleanliness of the patient. Aide services must be provided under the general
				  supervision of a registered nurse. Written instructions for patient care are to
				  be prepared by a registered nurse. A registered nurse must visit the home site
				  at least every 14 days when aide services are being provided, and the visit
				  must include an assessment of the aide services.
8. Physical therapy, occupational therapy and
				  speech-language pathology services provided for purposes of symptom control or
				  to enable the individual to maintain activities of daily living and basic
				  functional skills.
9. Any other
				  item or service which is included in the plan of care and for which payment may
				  otherwise be made under Medicaid is a covered service. The hospice is
				  responsible for providing any and all services indicated in the plan of care as
				  necessary for the palliation and management of the terminal illness and related
				  conditions.
10. Core Services
a. Nursing care, physicians' services,
				  medical social services and counseling are core hospice services and must
				  routinely be provided directly by hospice employees, except that physicians
				  services and counseling services may be provided through contract. Supplemental
				  services may be contracted for during periods of peak patient loads and to
				  obtain physician specialty services. The hospice may contract for a physician
				  to be a member of the hospices interdisciplinary group. Also, the hospices
				  Medical Director does not have to be an employee of the hospice. If contracting
				  is used for any core services, professional, financial and administrative
				  responsibility for the services must be maintained and regulatory qualification
				  requirements of all staff must be assured.
b. If located in a non-urbanized area, a
				  hospice may apply for a waiver of the core nursing, physical therapy,
				  occupational therapy, speech language pathology, and dietary counseling
				  requirements in accordance with
				  42
				  USC §1395x(dd).
11. Level of Care. Hospice care is
				  divided into four categories of care rendered to the hospice patient:
a. Routine Home Care Day. A routine home care
				  day is a day on which an individual who has elected to receive hospice care is
				  at home and is not receiving continuous care.
b. Continuous Home Care Day. A continuous
				  home care day is a day on which an individual who has elected to receive
				  hospice care is not in an inpatient facility and receives hospice care
				  consisting predominantly of nursing care on a continuous basis at home.
				  Continuous home care is only furnished during brief periods of crisis and only
				  as necessary to maintain the terminally ill patient at home.
i. If less skilled care is needed on a
				  continuous basis to enable the person to remain at home, this is covered as
				  routine home care.
ii. A period of
				  crisis is a period in which a patient requires continuous care which is
				  primarily nursing care to achieve palliation or management of acute medical
				  symptoms. Nursing care must be provided by either a registered nurse or a
				  licensed practical nurse and a nurse must be providing care for more than half
				  of the period of care.
iii. A
				  minimum of eight hours of care must be provided during a 24-hour day which
				  begins and ends at midnight. This care need not be continuous, i.e., four hours
				  could be provided in the morning and another four hours provided in the evening
				  of that day.
iv. Homemaker and aide
				  services may also be provided to supplement the nursing care.
c. Inpatient Respite Care Day. An
				  inpatient respite care day is a day on which the individual receives care in an
				  approved facility on a short-term basis, not to exceed five days in any one
				  election period, to relieve the family members or other persons caring for the
				  individual at home. An approved facility is one that meets the standards as
				  provided in 42 CFR §418.98(b) . This service cannot be delivered to individuals
				  already residing in a nursing facility.
d. General Inpatient Care Day. A general
				  inpatient care day is a day on which an individual receives general inpatient
				  care in an inpatient facility that meets the standards as provided in 42 CFR
				  §418.98(a) and for the purpose of pain control or acute or chronic symptom
				  management which cannot be managed in other settings.