Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-551 - Alternatives to hospital services › Subchapter I - HOSPICE SERVICES › Hospice-Payment › Section 182-551-1840 - Pediatric palliative care (PPC) case management/coordination services - Provider requirements

Current through Register Vol. 24-14, July 15, 2024
(1) An eligible
					 provider of pediatric palliative care (PPC) case management/coordination
					 services must do all of the following:
(a)
					 Meet the conditions in WAC
					 182-551-1300;
(b) Confirm that a client meets the
					 eligibility criteria in WAC
					 182-551-1810 prior to providing
					 the pediatric palliative care services;
(c) Place in the client's medical record a
					 written order for PPC from the client's physician;
(d) Determine and document in the client's
					 medical record the medical necessity for the initial and ongoing care
					 coordination of pediatric palliative care services;
(e) Document in the client's medical record:
(i) A palliative plan of care (POC) (a
					 written document based on assessment of a client's individual needs that
					 identifies services to meet those needs).
(ii) The medical necessity for those services
					 to be provided in the client's residence; and
(iii) Discharge planning.
(f) Provide medically necessary
					 skilled interventions and psychosocial counseling services by qualified
					 interdisciplinary hospice team members;
(g) Assign and make available a PPC case
					 manager (nurse, social worker or therapist) to implement care coordination with
					 community-based providers to assure clarity, effectiveness, and safety of the
					 client's POC;
(h) Complete and fax
					 the pediatric palliative care (PPC) referral and 5-day notification form (HCA
					 13-752) to the medicaid agency's PPC program manager within five working days
					 from date of occurrence of the client's:
(i)
					 Date of enrollment in PPC.
(ii)
					 Discharge from the hospice agency or PPC program when the client:
(A) No longer meets PPC criteria;
(B) Is able to receive all care in the
					 community;
(C) Does not require any
					 services for sixty days; or
(D)
					 Discharges from the PPC program and enrolls in the medicaid hospice
					 program.
(iii) Transfer
					 to another hospice agency for pediatric palliative care services.
(iv) Death.
(i) Maintain the client's file which includes
					 the POC, visit notes, and all of the following:
(i) The client's start of care date and dates
					 of service;
(ii) Discipline and
					 services provided (in-home or place of service);
(iii) Case management activity and
					 documentation of hours of work; and
(iv) Specific documentation of the client's
					 response to the palliative care and the client's and/or client's family's
					 response to the effectiveness of the palliative care (e.g., the client might
					 have required acute care or hospital emergency room visits without the
					 pediatric palliative care services).
(j) Provide when requested by the medicaid
					 agency's PPC program manager, a copy of the client's POC, visit notes, and any
					 other documents listing the information identified in subsection (1)(i) of this
					 section.