Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 58 - HOSPICE › Section 317:30-5-532 - Coverage for children

Current through Vol. 41, No. 20, July 1, 2024
Hospice is palliative and/or comfort care provided to the
					 member and his/her family when a physician certifies that the member has a
					 terminal illness and has a life expectancy of six months or less. A hospice
					 program offers palliative and supportive care to meet the special needs arising
					 out of the physical, emotional and spiritual stresses which are experienced
					 during the final stages of illness and death. Hospice services must be related
					 to the palliation and management of the member's illness, symptom control, or
					 to enable the individual to maintain activities of daily living and basic
					 functional skills.
(1) Payment is made
				  for home based hospice services for terminally ill individuals with a life
				  expectancy of six months or less when the member and/or family has elected
				  hospice benefits. Hospice services are available to eligible members without
				  forgoing any other service to which the member is entitled under SoonerCare for
				  curative treatment of the terminal illness. Once the member has elected hospice
				  care, the hospice medical team assumes responsibility for the member's medical
				  care for the terminal illness in the home environment. Hospice providers are
				  not responsible for curative treatments for members that elect such services
				  while on hospice. Hospice care includes nursing care, physician services,
				  medical equipment and supplies, drugs for symptom control and pain relief, home
				  health aide and personal care, physical, occupational and/or speech therapy,
				  medical social services, dietary counseling and grief and bereavement
				  counseling to the member and/or family. Services must be prior
				  authorized.
(2) Hospice care is
				  available for two 90-day periods and an unlimited number of 60-day periods
				  during the remainder of the member's lifetime. Beginning January 1, 2011, a
				  hospice physician or nurse practitioner must have a face to face encounter with
				  the member to determine if the member's terminal illness necessitates
				  continuing hospice care services. The encounter must take place prior to the
				  180th day recertification and each subsequent recertification thereafter; and
				  attests that such visit took place. The member and/or the family may
				  voluntarily terminate hospice services. Hospice services must be reasonable and
				  necessary for the palliation or management of a terminal illness or related
				  conditions. A certification that the individual is terminally ill must be
				  completed by the member's attending physician or the Medical Director of an
				  Interdisciplinary Group. Nurse practitioners serving as the attending physician
				  may not certify the terminal illness; however, effective January 1, 2011, nurse
				  practitioners may re-certify the terminal illness.
(3) Services must be prior authorized. A
				  written plan of care must be established before services are provided. The plan
				  of care should be submitted with the prior authorization request.
Added at 23 Ok Reg 29,
					 eff 8-1-05 (emergency); Added at 23 Ok Reg 1354, eff 5-25-06; Amended at 28 Ok
					 Reg 511, eff 1-6-11 (emergency); Amended at 28 Ok Reg 1489, eff
					 6-25-11