Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1130 - HOSPICE SERVICES
COVERED SERVICES
Section 1130.61 - Prerequisites for coverage

Universal Citation: 55 PA Code ยง 1130.61

Current through Register Vol. 54, No. 12, March 23, 2024

To be covered, hospice services shall meet the following requirements:

(1) The services shall be reasonable and necessary for the palliation or management of the symptoms of the terminal illness as well as related conditions.

(2) The recipient shall have elected hospice care under § 1130.41 (relating to election of hospice care).

(3) A plan of care shall be established in accordance with Medicare regulations at 42 CFR 418.58 (relating to condition of participation-plan of care) before the services are provided.

(4) The services shall be consistent with the plan of care.

(5) A certification that the individual is terminally ill shall be completed under § 1130.22 (relating to duration of coverage).

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