Section 7 AAC 140.275 - Hospice care services(a) Before the department will give prior authorization to and pay for hospice care services provided to a recipient in the recipient's place of residence, the department must receive, no more than eight days after hospice care begins, (1) a certification, signed by the recipient's attending physician and the medical director of the hospice, 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; and(3) an election statement, signed by the recipient or the recipient's representative, that includes (A) the name of the designated hospice;(B) an acknowledgment by the recipient, or the recipient's representative, of an understanding of hospice care;(C) the effective date of the election;(D) an acknowledgment by the recipient, or the recipient's 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-covered 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 the recipient's option to revoke the election of hospice care at any time; and(F) an acknowledgment of the recipient's 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, adopted by reference in 7 AAC 160.900.(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 hospice care services are not paid separately from payments made for routine home care, continuous home care, inpatient respite care, or general inpatient care, as provided in 7 AAC 145.690: (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; nursing care must be routinely provided by employees of the hospice;(4) medical social services rendered by a social worker under the direction of a physician; medical social services rendered by a social worker under the direction of a physician must be routinely provided by employees of the hospice;(5) physical, occupational, and speech therapy;(6) 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;(7) home health aide and homemaker services provided in the recipient's home under the direction of a registered nurse;(8) 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, and up to one year following the death of the recipient; counseling services described in this paragraph must be routinely provided by employees of the hospice.(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 by 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 paid as continuous home care, a minimum of eight hours of care described in 42 C.F.R. 418.204, adopted by reference in 7 AAC 160.900, 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 paid as routine home care.(g) The interdisciplinary group required by (d) of this section must include a doctor of medicine or osteopathy, a registered nurse, a social worker, and a counselor.Eff. 2/1/2010, Register 193Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040