Current through Register Vol. 24-18, September 15, 2024
(1) An
eligible provider of pediatric palliative care (PPC) case
management/coordination services must do all of the following:
(a) Meet the conditions in WAC
182-551-1300;
(b) Confirm that a client meets the
eligibility criteria in WAC
182-551-1810 prior to providing
the pediatric palliative care services;
(c) Place in the client's medical record a
written order for PPC from the client's physician;
(d) Determine and document in the client's
medical record the medical necessity for the initial and ongoing care
coordination of pediatric palliative care services;
(e) Document in the client's medical record:
(i) A palliative plan of care (POC) (a
written document based on assessment of a client's individual needs that
identifies services to meet those needs).
(ii) The medical necessity for those services
to be provided in the client's residence; and
(iii) Discharge planning.
(f) Provide medically necessary
skilled interventions and psychosocial counseling services by qualified
interdisciplinary hospice team members;
(g) Assign and make available a PPC case
manager (nurse, social worker or therapist) to implement care coordination with
community-based providers to assure clarity, effectiveness, and safety of the
client's POC;
(h) Complete and fax
the pediatric palliative care (PPC) referral and 5-day notification form (HCA
13-752) to the medicaid agency's PPC program manager within five working days
from date of occurrence of the client's:
(i)
Date of enrollment in PPC.
(ii)
Discharge from the hospice agency or PPC program when the client:
(A) No longer meets PPC criteria;
(B) Is able to receive all care in the
community;
(C) Does not require any
services for sixty days; or
(D)
Discharges from the PPC program and enrolls in the medicaid hospice
program.
(iii) Transfer
to another hospice agency for pediatric palliative care services.
(iv) Death.
(i) Maintain the client's file which includes
the POC, visit notes, and all of the following:
(i) The client's start of care date and dates
of service;
(ii) Discipline and
services provided (in-home or place of service);
(iii) Case management activity and
documentation of hours of work; and
(iv) Specific documentation of the client's
response to the palliative care and the client's and/or client's family's
response to the effectiveness of the palliative care (e.g., the client might
have required acute care or hospital emergency room visits without the
pediatric palliative care services).
(j) Provide when requested by the medicaid
agency's PPC program manager, a copy of the client's POC, visit notes, and any
other documents listing the information identified in subsection (1)(i) of this
section.
(2) If the
medicaid agency determines the POC, visit notes, and/or other required
information do not meet the criteria for a client's PPC eligibility or does not
justify the billed amount, any payment to the provider is subject to recoupment
by the medicaid agency.
Statutory Authority:
RCW
41.05.021, Section 2302 of the Patient
Protection and Affordable Care Act of 2010 (
P.L.
111-148), and Section 1814(a)(7) of the Social
Security Act. 12-09-079, §182-551-1840, filed 4/17/12, effective 5/18/12.
11-14-075, recodified as §182-551-1840, filed 6/30/11, effective 7/1/11.
Statutory Authority:
RCW
74.08.090,
74.09.520. 05-18-033, §
388-551-1840, filed 8/30/05, effective
10/1/05.
