N.H. Admin. Code § He-W 544.10

Current through Register No. 50, December 12, 2024

Section He-W 544.10 - Covered Hospice Services

(a) The designated hospice provider shall create a care plan for the recipient in accordance with 42 CFR 418.56(c) that specifies the services to be provided to the recipient, which are reasonable and necessary for the palliation or management of the symptoms of the terminal illness and conditions or complications related to the terminal illness.

(b) Services covered as part of the hospice benefit shall include:

(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 bachelor's degree from a school accredited or approved by the council on social work education, and licensed practitioner;

(3) The following services performed by hospice licensed practitioner:

a. General supervisory services of the medical director;

b. Participation in the establishment of plans of care, supervision of care and services, periodic review and updating of plans of care, and establishment of governing policies by the licensed practitioner member of the interdisciplinary group; and

c. Licensed practitioner services described in He-W 544.16(b)(2);

(4) Counseling services, including bereavement, spiritual, and dietary counseling, provided to the recipient, family members, and others caring for the recipient for the purpose of training the recipient's family or caregivers to provide care;

(5) General inpatient care as follows:

a. Such care shall be provided in a medicaid enrolled hospice house, licensed in accordance with RSA 151 and He-P 824, hospital, or nursing facility that meets the requirements in 42 CFR 418.100 (a) and (e) regarding staffing and patient areas; and

b. Care shall be for pain control or symptom management which cannot be provided in another setting;

(6) Inpatient respite care provided to the recipient as follows:

a. Only for recipients who are not residing in a nursing facility;

b. Only when necessary to relieve the family members or other caregivers of caring for the recipient;

c. Not for more than one period of 5 consecutive days at a time per election period, except that the sixth and any subsequent consecutive days shall be covered and paid at the routine home care rate; and

d. Only in those intermediate care facilities that meet the requirements of 42 CFR 418.100 (a) and (e) regarding 24-hour nursing and patient areas;

(7) Durable medical equipment and supplies for self-help and personal comfort related to the palliation or management of the recipient's terminal illness or conditions related to the terminal illness while the recipient is under hospice care;

(8) Drugs for the palliation and management of the recipient's terminal illness or conditions related to the terminal illness;

(9) Home health aide and homemaker services;

(10) Physical therapy, occupational therapy, and speech language pathology services for the purpose of symptom control or to enable the recipient to maintain activities of daily living and basic functional skills;

(11) Transportation;

(12) Any other service that is specified in the recipient's care plan as reasonable and necessary for the palliation and management of the recipient's terminal illness and related conditions; and

(13) Continuous home care, which shall be:

a. Provided in the community setting of the recipient's place of residence;

b. Provided only during a period of crisis, which is a period in which a recipient requires continuous care which is primarily nursing care to achieve palliation or management of acute medical symptoms;

c. Provided by a registered nurse or licensed practical nurse, who shall provide care for more than half the period of care; and

d. Only for brief periods of crisis and only as needed to maintain the recipient's care in the home.

(c) The recipient's care plan shall include bereavement counseling for the recipient's family after the recipient's death.

(d) Bereavement counseling in (c) above shall not be billable to medicaid nor to the recipient's family.

N.H. Admin. Code § He-W 544.10

#9726-A, eff 7-1-10

Amended by Number 6, Filed February 8, 2024, Proposed by #13847, Effective 1/6/2024, Expires 1/6/2034 (formerly He-W 544.09) (See Revision Note at part heading for He-W 544).