New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 544 - HOSPICE SERVICES
Section He-W 544.09 - Covered Hospice Services
Universal Citation: NH Admin Rules He-W 544.09
Current through Register No. 40, October 3, 2024
(a) The designated hospice provider shall create a plan of care for the recipient in accordance with 42 CFR 418.56 a.2(b) 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 who is working under the
direction of a physician;
(3) The
following services performed by hospice physicians:
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 physician member of the interdisciplinary group; and
c. Physician services described in
He-W
544.16(b) (2) a.;
(4) Counseling services, including
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 Title XIX enrolled hospice house, licensed in
accordance with RSA 151 and He-P 824, hospital, or nursing facility that meets
that meets the requirements in
42 CFR
418.110 regarding staffing and patient areas;
and
b. Care shall be for pain
control or symptom management which cannot be provided in an outpatient
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) Ambulance and wheelchair van
transportation;
(12) Any other
service that is specified in the recipient's plan of care 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 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;
b. Provided by a registered nurse or licensed
practical nurse, who shall provide care for more than half the period of care;
and
c. A minimum of 8 hours of care
during a 24-hour day, which shall not be required to be consecutive
hours.
(c) The recipient's plan of care 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 Title XIX nor to the recipient's family.
#9726-A, eff 7-1-10
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