Title 7 . Health and Social Services

Chapter 43 . Hearings

Section 938. Hospice care

7 AAC 43.938. Hospice care

(a) The division will, in its discretion, reimburse for hospice care services provided to a recipient in the recipient's place of residence if the division has received

(1) a certification, signed by the recipient's attending physician and the medical director of the hospice within eight days after hospice care begins, that the recipient's medical prognosis is a life expectancy of six months or less if the illness runs its normal course;

(2) a copy of the recipient's care plan described in (d) of this section within eight days after hospice care begins; and

(3) an election statement, signed by the recipient or the recipient's authorized representative, that includes

(A) the name of the designated hospice;

(B) an acknowledgment by the recipient, or the recipient's authorized representative, of an understanding of hospice care;

(C) the effective date of the election;

(D) an acknowledgment by the recipient, or the recipient's authorized representative, that for the duration of care, the recipient waives the recipient's rights to hospice care by any other hospice unless arranged through the designated hospice, and waives the recipient's rights to any other Medicaid-reimbursable services related to the recipient's terminal illness except for those provided by the designated hospice, an alternative hospice under arrangement with the designated hospice, or the recipient's attending physician;

(E) an acknowledgment of an option to revoke the election of hospice care at any time; and

(F) an acknowledgment of an option to elect to change the designation of the hospice by submitting to both hospices a signed statement indicating the hospice from which care has been received, the newly designated hospice, and the date the change is effective; the recipient may only elect to change the designation of the hospice once in each election period as described in 42 C.F.R. 418.21 and 418.30, revised as of October 1, 1994.

(b) A recipient eligible for Medicare and Medicaid must make an election of a hospice, a designation of change of a hospice, or a revocation of a hospice simultaneously for both programs.

(c) The following services are core hospice services reimbursed as either routine care, continuous home care, inpatient respite care, or general inpatient care, as provided in 7 AAC 43.939:

(1) preparation of a written plan of care that meets the requirements of (d) of this section;

(2) a service rendered that is consistent with the written plan of care;

(3) nursing care provided under the direction of a registered nurse;

(4) medical social services rendered by a social worker under the direction of a physician;

(5) physician services rendered by the hospice medical director or by the physician member of the interdisciplinary group who is licensed as a doctor of medicine or osteopathy;

(6) physical, occupational, and speech therapy;

(7) durable medical equipment, medical supplies, and biologicals and drugs that are used primarily for the relief of pain and symptom control of the terminal illness;

(8) home health aide and homemaker services provided in the recipient's home under the direction of a registered nurse;

(9) counseling services provided to the recipient, family members, or caregiver for the purpose of enabling the family or caregiver to provide care, or aiding in adjustment to the recipient's approaching death;

(10) general inpatient care;

(11) short-term inpatient respite care; and

(12) hospice care provided to a recipient residing in a nursing facility or intermediate care facility for the mentally retarded, if the hospice and the facility have a written agreement specifying the responsibilities of each, and the recipient has elected hospice care under this chapter; the facility shall, at a minimum, provide personal care services, administration of medication, maintenance of the recipient's room, and supervision and assistance in the use of durable medical equipment and prescribed therapies.

(d) A hospice care provider shall prepare a written plan of care that contains an initial plan of care expanded to a comprehensive plan of care. Before hospice service begins, a written initial plan of care must be completed by a registered nurse or physician in cooperation with at least one member of the interdisciplinary group. A comprehensive plan of care must be reviewed and updated at intervals, specified in the plan, by the hospice medical director or the recipient's attending physician, and the interdisciplinary group. The plan must include an assessment of the recipient's needs and state in detail the scope and frequency of services needed to meet the recipient's and family's needs.

(e) Nursing care, physician services, medical social services, and counseling are core hospice services and must be routinely provided by hospice employees. Physician services provided by the hospice must also meet the general medical needs of the recipient to the extent that the needs are not met by the recipient's attending physician.

(f) Continuous home care is to be provided only during a period of crisis in which a recipient requires constant care to reduce or manage acute medical symptoms as necessary to maintain a recipient at home. To be reimbursed as continuous home care, a minimum of eight hours of care described in 42 C.F.R. 418.204, revised as of October 1, 1994, must be provided in each 24-hour period, and may be supplemented with homemaker and home health aide services; more than half of the continuous home care hours must be nursing care. If care less skilled than nursing services is required on a continuous basis to maintain the recipient at home, that care will be reimbursed as routine home care.

(g) The interdisciplinary group required by (c) and (d) of this section must include a doctor of medicine or osteopathy, a registered nurse, a social worker, and a counselor.

History: Eff. 8/13/95, Register 135

Authority: AS 47.05.010

AS 47.07.030

AS 47.07.040