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Minnesota Department of Human Services Provider Manual
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Hospice Services

Revised: 07-29-2015

  • • Overview
  • • Eligible Providers
  • • Eligible Recipient
  • • Covered Services
  • • Hospice Care Provided In Conjunction with Other MA-Covered Services
  • • Pre-existing health care needs
  • • Medical needs that arise during the period of the hospice benefit but which are unrelated to the terminal illness
  • • How to Determine When a MA-Covered Service Duplicates of a Hospice Benefit Service
  • • Documentation Requirements When A Case Manager is Involved
  • • Seeking HCBS After Hospice Election
  • • County Case Manager Approval of Services that are Concurrent with the Hospice Benefit
  • • Physician Services
  • • Billing for Consulting Physician Services
  • • Establishing the Plan of Care
  • • Content of Plan of Care
  • • Review of Plan of Care
  • • Hospice Services for Residents of Long Term Care Facilities
  • • Bed-hold Billing
  • • Hospice Transaction Form
  • • Submitting the Hospice Transaction Form
  • • MHCP Member Information
  • • Election of Hospice Services- age 22 and older
  • • Election of Hospice Services- age 21 and under
  • • Medicare Election
  • • Elected Hospice Provider
  • • Certification of Terminal Illness
  • • Discharge Statement
  • • Revocation of Hospice Services
  • • Change of Designated Hospice Provider
  • • Recipient Date of Death
  • • Noncovered Services
  • • Hospice Payments and Limits
  • • Billing Hospice Services
  • • Billing Hospice Physician Services
  • • Billing Medical Supplies and Equipment
  • • Definitions
  • • Legal References
  • Provider Type Home Page Links
    Review related web pages for the latest news and additions, forms, and quick links.

    Overview

    The hospice benefit is a comprehensive package of services offering palliative care support to terminally ill recipients and their family. Hospice care offers holistic support and relief from pain and other symptoms of the terminal illness.

    When recipients who are 22 years old and older voluntarily elect hospice benefits, they agree to forego care that attempts to cure their terminal illness or condition.

    Recipients 21 years old or younger who elect hospice benefits do not waive their coverage for services that are related to the treatment of the terminal illness or condition. The hospice plan of care must identify treatment for the terminal illness that will continue.

    The hospice benefit is available to recipients who have been certified by a physician as terminally ill. A recipient is considered terminally ill if he or she has a medical prognosis with life expectancy of six months or less when the disease runs its normal course. Hospice may be in effect longer than six months. Recipients who meet these requirements may elect the hospice benefit. Dually eligible recipients who elect the Medicare hospice benefit must also elect the Medical Assistance (MA) hospice benefit. The hospice provider must inform recipients with a terminal illness of all MA services and support options, including the hospice benefit. Hospice care is optional and the recipient may revoke their election at any time.

    The MA hospice benefit follows the same rules and regulations as the Medicare hospice benefit, which was designed to supplement the care that primary caregivers, such as family (as the recipient defines family), friends and neighbors provide. The hospice benefit is not intended to replace the supportive role of the recipient's informal support network of primary caregivers. As such, MA-covered services that replace the duties of primary caregivers do not duplicate the hospice team's services. Examples of supportive functions that primary caregivers provide include the following:

  • • Coordinating the recipient's care
  • • Performing personal care
  • • Helping with activities of daily living
  • • Providing nutrition
  • • Helping with medications
  • Examples of services that may resemble the supportive role provided by primary care givers include the following:

  • • Adult foster care services
  • • Personal care assistant services
  • • Home delivered meals
  • • Lifeline
  • • Community Alternative Care (CAC), Community Alternatives for Disabled Individuals (CADI), Brain Injury (BI), Elderly Waiver (EW), and Developmental Disabilities (DD) waiver services, and the Alternative Care program
  • Eligible Providers

    A hospice organization may enroll as an MHCP hospice provider if it is licensed and certified for Medicare as a hospice by the Minnesota Department of Health. For hospice services to be covered, the elected hospice provider must establish a plan of care before providing services.

    A hospice may use contracted staff to supplement hospice employees during periods of peak recipient loads or other extraordinary circumstances. The hospice remains responsible for the quality of services provided by contracted staff.

    Eligible Recipient

    To be eligible for hospice services, a recipient must be:

  • • MA (Medicaid) or MinnesotaCare eligible; and
  • • Certified as terminally ill by the medical director of the hospice, or a physician member of the interdisciplinary group, and the recipient's attending physician, if he or she has one.
  • Direct MA recipients who may be eligible for Medicare to the Social Security Administration for Medicare application.

    Direct MinnesotaCare recipients to their local county human services agency for MA eligibility determination.

    Dually eligible recipients (members who are eligible for both Medicare and Medicaid) who elect MA hospice must also elect Medicare hospice. The elected hospice provider must send the Medicare hospice election information and the MHCP Hospice Transaction Form (DHS-2868) (PDF) to DHS within two days of election.

    A recipient may receive hospice care until either of the following occurs:

  • • They are no longer certified as terminally ill
  • • The recipient or his or her representative revokes the election of hospice care
  • Covered Services

    Hospice benefits include coverage for the following services, when provided directly in response to the terminal illness:

  • • Physician services
  • • Nursing services
  • • Medical social services
  • • Counseling
  • • Medical supplies and equipment
  • • Outpatient drugs for symptom and pain control
  • • Dietary and other counseling
  • • Short-term inpatient care
  • • Respite care
  • • Home health aide and homemaker services
  • • Physical, occupational, and speech therapy
  • • Volunteers
  • • Other items and services included in the plan of care that are otherwise covered medical services
  • Hospice care provided In conjunction with other MA-covered services

    DHS understands that recipients facing death may have a complex set of health care needs. These needs often stem from their terminal condition. These needs may also stem from other medical conditions that either (a) pre-existed their terminal condition, or (b) arise during the course of their terminal condition but are unrelated to their terminal condition. A recipient should never be asked to make an "either/or" choice between an otherwise MA-covered, medically necessary service which is not related to the terminal condition, and covered, medically necessary hospice benefit service that is related to the terminal condition.

    Pre-existing health care needs

    Some MA-covered services may already be needed and in place before the recipient seeks hospice, due to the recipient's pre-existing medical conditions or disability. The hospice benefit is not intended to duplicate health services or supports that relate to a pre-existing condition. Examples include continuing care services such as home care related to a previous stroke, waiver services related to a disability, or adult foster care related to a disability such as elderly dementia. Examples of pre-existing medical care include services for conditions such as diabetes, ALS, arthritis, cardiac conditions, AIDS, or high blood pressure.

    Pre-existing continuing care services may need to be adjusted during the period that the recipient is receiving the hospice benefit. Recipients with pre-existing needs, such as quadriplegia or stroke, may have more intensive physical needs due to the terminal illness than people without such pre-existing conditions do. The resulting higher needs are an interaction of the two conditions together, some of which may need to be addressed through increased continuing care services.

    Medical needs that arise during the period of the hospice benefit but which are unrelated to the terminal illness

    Sometimes recipients need new health care services in addition to the services offered as part of the hospice benefit. MA-covered services may be provided in response to conditions not related to the terminal condition. Examples of this include treatment for a hip fracture unrelated to the terminal diagnosis, or the development of a new condition or symptom unrelated to the terminal diagnosis.

    How to determine when a MA-covered service duplicates a hospice service

    Generally, the determination about whether a service duplicates a hospice benefit service will be made as part of the hospice provider's general responsibility to provide care coordination. The hospice care coordinator must assume the lead responsibility for collaborating with the county case manager, home care agency, physician, or other provider providing the services, which are outside of the hospice benefit.

    Because some hospice benefit services and MA-covered services may be similar, this determination process should focus on the purpose, rather than the type of service -- that is, which recipient need is the service addressing?

    The following considerations may be helpful in approaching the determination.

  • Is the purpose of a service:
  • • To address a pre-existing condition or a pre-existing need?
  • • To address a health care problem that would have existed even without the terminal illness?
  • • To facilitate the recipient's ability to live in the community setting rather than an institution; and would that need have been present with or without the terminal illness?
  • Documentation requirements when a case manager is involved

    When the MA-covered service is the type that includes home and community-based services (HCBS) case management, the hospice must notify the case manager in writing of the recipient's election of hospice and the anticipated start date. The hospice provider must give written notice by fax, mail, or hand delivery to the case manager within two business days using the Hospice Transaction Form (DHS-2868) (PDF).

    The hospice agency staff must assume lead responsibility for collaboration with the case manager and must document that collaboration. The hospice staff must forward the documentation within eight calendar days of the effective date of hospice services. Collaboration may be completed via telephone, fax, email, or a face-to-face visit. Include documentation in the recipient's hospice record.

    The case manager will be invited to participate in the hospice interdisciplinary care team meetings for a recipient receiving home and community-based services.

    The case manager will keep a copy of the cooperative agreement in the recipient's record. (This is not a mandated form but a tool to use for preventing duplication of services.)

    When the recipient is receiving "traditional MA" home care and no case manager is involved, the hospice must coordinate care and communicate with the home care agency involved with the recipient, rather than through a county case manager.

    Seeking HCBS after Hospice Election

    When a recipient is receiving concurrent HCBS and hospice services, the HCBS are usually in place before the hospice services began.

    There may be situations where a recipient seeks case-managed HCBS or an increase in HCBS, after electing the hospice benefit. Example: An adult with a disability is living with an aging mother, who is the primary caregiver. The aging mother experiences a decline in health status, and has to cut back on the amount of primary care she is able to provide the recipient. The recipient therefore applies for HCBS to access available services and supports that the primary caregiver can no longer provide. In situations where the initial HCBS is added or increased after the recipient elects hospice benefits, county case management documentation must justify the addition or increase of the HCBS services.

    County case manager approval of services that are concurrent with the hospice benefit

    An MMIS informational edit will appear on the HCBS service agreement to alert counties that the recipient has elected the hospice benefit. Following coordination with the hospice provider agency, county case managers must add comments on the county DHS Comment Screen of the MMIS service agreement, documenting the coordination of services. The notes must indicate why continuing care services are necessary. (Either they are pre-existing, or they are new but treated as a condition not related to the terminal condition.) The MMIS service agreement line items must be adjusted as needed to reflect the type and amount of services required. Changes to services continue to require a ten-day notice to recipients to allow for continuity of care, recipient rights, and transitional needs.

    When DHS receives continuing care waiver or Alternative Care provider claims, a claim edit suspends the claim when the date of service overlaps with the hospice benefit period. Because the hospice provider becomes the primary payer of services, DHS will manually review HCBS provider claims to determine if payment is appropriate. DHS will review case management notes in MMIS at that time to ensure the hospice provider coordinated with the county case manager. If it appears that the coordination by the hospice provider has not occurred, the claim will remain in suspense until the coordination process is completed. If it appears that the coordination process has occurred and payment is appropriate, then the claim will be paid. The informational edit and manual review of claims will remain in place temporarily to encourage consistent coordination between the provider areas.

    Physician Services

    An attending physician's services are separately billable as long as the attending physician is not an employee of or under contract with the hospice. Bill Medicare Part B for dual eligible recipients and MA if the person has MA only.

    Billing for Consulting Physician Services

    When billing for the services of a consulting physician for an MA-only recipient (no Medicare or other third party payer involved), break out the technical portion and bill MHCP for the physician portion only.

    Services provided to dual eligible recipients are first billed to Part B Medicare and cross-over for MA payment of co-pays and deductibles.

    Establishing the Plan of Care

    The attending physician, the hospice medical director or physician designee, and the interdisciplinary group must establish a written plan of care for providing hospice services. The care provided by the hospice must follow the established plan of care.

    Content of Plan of Care

    The written plan of care must include the following:

  • • An assessment of the recipient's needs
  • • Services needed, including the management of discomfort and symptom relief
  • • Detail the scope and frequency of services needed to meet the recipient's and family's needs
  • The elected hospice provider must designate a registered nurse to coordinate implementing the plan of care for each recipient.

    The plan of care must be in place and a designated registered nurse identified, before providing hospice service.

    Review of Plan of Care

    The attending physician, the hospice medical director or physician designee, and the interdisciplinary group must review and update the plan of care at intervals specified in the plan. The reviews must be documented.

    Hospice Services for Residents of Long Term Care Facilities

    MA eligible residents of Intermediate Care Facilities for the Developmentally Disabled (ICF/DDs) and nursing facilities (NFs) who also meet hospice service eligibility may elect to receive hospice services where they live. The hospice provider becomes the primary provider of the service, and authorizes and funds the hospice benefits. Medicare and MA payments are made to the hospice provider for both the hospice services it provides, and for the residential services the facility provides. Current law requires a payment to the hospice provider of at least 95% of the rate that would have been paid for facility services for the individual. Payments to be made by DHS are indicated in column (E):

    Facility Type (A)

    DHS Payment Rate (B)

    Percentage of Rate (C)

    Private Room (D)

    Hospice Payment For Room & Board (E)

    ICF/DD

    ICF/DD

    100%

     

    95% * [(B)*(C)]

    NF

    NF Case Mix

    100%

     

    95% * [(B)*(C)]

    NF

    NF Case Mix

    100%

    111.5%

    95% * {[(B)*(D)]*(C)}

    NF First 30 Days1

    NF Case Mix

    120%

     

    95% * [(B)*(C)]

    NF First 30 Days1

    NF Case Mix

    120%

    111.5%

    95% * {[(B)*(D)]*(C)}

    out-of-state NF

    NF Rate

    100%

     

    95% * [(B)*(C)]

    1 Begins with date of NF admission, not MA eligibility date.

    The hospice must contract with and negotiate a rate with the long-term care facility for the recipients who reside in the facility and elect hospice care. The long-term care facility must coordinate with the hospice all of the recipient's services and care. The elected hospice provider may negotiate with the long-term care facility for the long-term care facility to continue to collect the recipient's spenddown.

    The elected hospice provider must notify the local county human services agency of the recipient's hospice election by sending (or faxing) a copy of the front page of the Hospice Transaction Form (DHS-2868) (PDF) to the county. The hospice will become the designated provider for the medical spenddown, and the payment to the hospice for the room and board will exclude the amount of the recipient's medical spenddown.

    Residents of ICF/DDs and NFs may receive end-of-life care from their residential provider without making the hospice election. Facilities may be able to arrange for the specific care needs of people with terminal illness by making internal staffing adjustments, or by also purchasing the specialized services, or making staff additions. ICF/DD facilities may apply through their host counties for a variable rate adjustment to accommodate the increased needs of a person with terminal illness.

    Bed-hold Billing

    When a hospice patient resides in a nursing home and is absent from the nursing home for hospitalization, home visits, etc., the hospice agency must verify that the nursing facility is eligible for the bed-hold day(s). Bed-hold day(s) are available for up to 18 consecutive days per hospital admission and 36 days annually for therapeutic leave days when the facility occupancy rate is 96% or greater. Bed-hold day rates are 30% of the case-mix rate, of which the agency is entitled to 95% of the adjusted case-mix rate for that LTC facility.

    Example: If the entire stay is May 1-10 with May 1-7 in the nursing home, submit revenue code 0658 with the case-mix for May 1-7; for the May 8-10 hospital stay days, submit revenue code 0185 with only the rate of charges billed.

    Revenue code 0185 will pay only the submitted amount and can only be used for hospital or therapeutic leave days when billing for hospice.

    Hospice Transaction Form

    The MHCP Hospice Transaction Form (DHS-2868) (PDF) is a multipurpose form that is a tool for hospice providers to report hospice election, certification, revocation of hospice services, change of hospice provider, and recipient death.

    Submitting the Hospice Transaction Form

    The elected hospice provider must notify DHS when a recipient chooses to enroll in hospice within two days of the hospice election. Notify DHS regardless of whether MA is the primary payer.

    Submit the Medicare and Medicaid (MA) approved criteria to DHS immediately upon enrolling with Medicare hospice on the hospice agency's election form. Complete this election form with all the required or appropriate information (for example, the recipient’s MHCP member ID number, date of birth, MHCP provider NPI, the current ICD code and patient's signature).

    The hospice provider may submit the Medicare approved hospice election criteria and the DHS required elements to DHS in place of the MHCP hospice transaction form dual eligible Medicare and MA recipients

    Send page one of the election form to the county financial worker when the recipient has a spenddown. State staff will make the institutional to medical change in the system if the county does not change it.

    For recipients enrolled in a prepaid health plan, only submit their hospice election forms to DHS if they are residing in a long-term care facility.

    The elected hospice provider must notify DHS when the recipient is no longer receiving hospice care. Complete the appropriate sections of the Hospice Transaction form.

    Fax the completed form to 651-431-7554.

    MHCP Member Information

    Election of Hospice Services- age 22 and older

    Enter the date the member has selected to begin hospice services.

    The elected hospice provider must do the following:

  • • Explain the benefits the recipient will receive
  • • Explain the benefits the recipient is waiving
  • • Give the recipient or legal representative a copy of the signed hospice transaction form
  • • Retain the signed hospice transaction form in its files
  • The recipient or a legal representative (if the recipient is physically or mentally unable) must sign and date the transaction form to elect hospice care and waive rights to any other medical services related to the treatment of the terminal condition. A witness signature is required only when the recipient is not able to sign.

    Election of Hospice Services- age 21 and under

    Enter the date the member has selected to begin hospice services.

    The elected hospice provider must do the following:

  • • Explain the benefits the recipient will receive
  • • Explain the benefits the recipient is waiving
  • • Give the recipient or legal representative a copy of the signed hospice transaction form
  • • Retain the signed hospice transaction form in its files
  • The recipient or a legal representative (if the recipient is physically or mentally unable) must sign and date the hospice transaction form to elect hospice care. A witness signature is required only when the recipient is not able to sign.

    Enter the hospice recipient's name, address, MHCP ID number, and date of birth.

    Medicare Election

    If the recipient is both Medicare and Medicaid eligible, he or she must elect Medicare hospice care in addition to Medicaid hospice care. Federal guidelines prohibit recipients from choosing hospice care through one program and not the other when they are eligible for both. Select Yes, to indicate that, as the elected hospice provider, you have explained that when a person is dual eligible they must use their Medicare benefits, as well as their Medicaid benefits for hospice service to be covered.

    Elected Hospice Provider

    The election statement must include the name, NPI number, and address, phone and fax number of the MHCP provider that will provide the hospice care.

    Certification of Terminal Illness

    The elected hospice provider must send a copy of the hospice transaction form to the attending physician or nurse practitioner (primary care provider) for them to verify that the recipient has a terminal illness with a life expectancy of six months or less. DHS must receive the form within two days of when the recipient signed it. If the hospice provider cannot obtain written certification within two calendar days of service initiation, they may substitute oral certification. The person obtaining oral certification must acknowledge receiving oral certification by signing the hospice transaction form. The hospice provider must follow up by obtaining and submitting written certification no later than eight calendar days after service initiation.

    Diagnoses such as "failure to thrive" or "weakness" are invalid hospice election diagnoses.

    Discharge Statement

    Complete the discharge statement if a recipient is no longer considered to have a life expectancy of six months or less or the recipient is no longer eligible to receive hospice services and is discharged from the hospice program. The hospice medical director or designee and attending physician must sign and date the statement.

    Revocation of Hospice Services

    A hospice recipient may elect, at any time, to receive curative care and terminate hospice services. The recipient or a legal representative must sign and date revocation of hospice services. The effective date of the revocation must be on or after the date the form is signed.

    Change of Designated Hospice Provider

    A recipient may change hospice providers while receiving hospice services. Enter the names and NPI numbers of both the new and replaced hospice providers. Both hospice providers must retain copies of the hospice transaction form. DHS and the county, if applicable, must be notified of the change.

    Recipient Date of Death

    The hospice must enter the recipient's date of death. DHS must receive a copy of the hospice transaction form within two days of the recipient's date of death.

    Noncovered Services

    The following services are not covered and must be waived while the recipient is in hospice care:

  • • Other forms of health care for treatment of:
  • • The terminal illness for which hospice care was elected
  • • A condition related to the terminal illness
  • • Other hospice services or hospice services equivalent to hospice care, except those provided by the designated hospice or its contractors
  • • Services provided under home and community-based services waivers that are related to the terminal illness
  • Hospice Payments and Limits

    Hospice providers are paid at one of the four fixed daily rates that apply to all services except certain physician services, and room and board in a long-term care facility.

    MHCP will pay a hospice for each day a recipient is under the hospice's care. The payment methodology and amounts are the same as used by the Medicare program.

    The limits and cap amounts are the same as used in the Medicare program except that the inpatient day limit on both inpatient respite days and general inpatient days do not apply to recipients afflicted with AIDS.

    Additional payment is not made for bereavement counseling.

    The hospice may be paid for an amount that does not exceed the hospice cap payment. Room and board payments for a long-term care facility and certain payments to the recipient's attending physician are not considered when the cap amount is calculated.

    Billing Hospice Services

    Refer to the following for billing information:

  • • Use the 837I claim form
  • • Use one of the following for type of bill:
  • • 811 Non-hospital based hospice (817 for non-hospital based hospice replacement claims)
  • • 821 Hospital based hospice (827 for hospital based hospice replacement claims)
  • • For Home Care, use one of the following revenue codes:
  • • 0651 Routine home care day (less than 8 hours):
  • • Enter the appropriate HCPCS code (Code range Q5001 - Q5009) identifying the level of care provided for each service line
  • • Report units as days. (1 day = 1 unit; 30 days = 30 units)
  • • 0652 Continuous home care day, 8 or more hours of nursing care each day up to 24 hours per day:
  • • Enter the appropriate HCPCS code (Code range Q5001 – Q5009) identifying the level of care provided for each service line
  • • Report units in 15-minute increments. (8 hours = 32 units, 24 hours = 96 units)
  • When billing claims with the Q HCPCS codes, providers will have to do splint billing with only one Q code per claim. Billing more than one Q HCPCS code on a claim will cause the claim to deny.

    When billing routine home care or continuous home care (revenue codes 0651 and 0652, respectively), enter value code 61 and the appropriate 5-digit Core Based Statistical Area (CBSA) code to identify the location where the hospice care was provided. The codes are the same for Medicare and MA.

    If the value code or CBSA code is not entered, DHS will deny the claim.

    Refer to the following:

  • • 0655 Inpatient respite day – billing may include date of admission but not date of discharge, unless discharged deceased
  • • 0656 General inpatient day – billing may include date of admission but not date of discharge, unless discharged deceased
  • The total number of general inpatient care days and inpatient respite care days must not exceed 20% of the total days provided to a hospice recipient.
  • • 0658 Hospice room and board – recipients must meet the following criteria:
  • • Reside in a long-term care facility (nursing home or ICF/DD)
  • • Be billed fee-for-service
  • DHS does not pay for the discharge day, even upon death, while a recipient is residing in a LTC facility.

    Billing Hospice Physician Services

    Refer to the following:

  • • Use the 837P Professional claim form
  • • Use appropriate CPT or HCPCS codes and any applicable modifiers
  • • On the Provider Tab, enter the MHCP physician's NPI and indicate Rendering in the Other Provider Types section. If reporting more than one rendering provider select the appropriate name in the Service Level Providers section on the Services Tab
  • • Enter the NPI of the MHCP hospice provider as the Billing Provider in MN–ITS
  • • The hospice payment for physician services is the MHCP physician payment rate, and is included in the hospice cap amount
  • • Patient care services not related to the terminal illness rendered by an independent attending physician (a physician who is not considered employed or under contract with the hospice) must be billed using physician billing guidelines (refer to the Physician section of this manual), and are not part of the hospice cap amount
  • • Do not submit denied Medicare physician payments that are related to the terminal illness
  • • Denied Medicare payments for physician services must have an attachment stating the reason(s) Medicare denied the services. (Services must not be related to the terminal illness)
  • Billing Medical Supplies and Equipment

    Claims for medical supplies and equipment outside of the hospice benefit must include a signed statement from the hospice physician indicating why the equipment or supply was not related to the terminal condition.

    Definitions

    Cap Amount: The limit on overall hospice payment.

    Crisis: A period during which the recipient requires continuous care for palliation or management of acute medical symptoms.

    Continuous Home Care Day: A day in which the recipient receives nursing services, including home health or homemaker services, on a continuous basis during a period of crisis, for at least eight hours and as many as 24 hours per day, as necessary to maintain the recipient at home. More than half the care during the crisis must be nursing care provided by a registered nurse or licensed practical nurse. The hospice uses the hourly rate for the actual hours of services provided, up to 24 hours.

    Employee: An employee of the hospice or, if the hospice is a subdivision of an agency or organization, an employee of the agency or organization assigned to the hospice unit, including a volunteer under the supervision of the hospice.

    General Inpatient Day: A day in which the recipient receives general inpatient care in a hospital, skilled nursing facility, or inpatient hospice unit for control of pain or management of acute or chronic symptoms that cannot be managed in the home.

    Home: The recipient's place of residence.

    Hospice Care: The services provided by a hospice to a terminally ill recipient.

    Inpatient Care: The hospice services provided by an inpatient facility to a recipient who has been admitted to a hospital, long-term care facility, or facility of a hospice that provides care 24 hours per day.

    Inpatient Facility: A hospital, long-term care facility, or facility of a hospice that provides care 24 hours per day.

    Interdisciplinary Group: A group of qualified individuals with expertise in meeting the special needs of hospice recipients and their families, including, at a minimum, providers of core services. An interdisciplinary group must have at least one physician, one registered professional nurse, one social worker, and one pastoral or other counselor.

    Legal Representative: A person who, under Minnesota law, may execute or revoke an election of hospice care on behalf of the recipient because the terminally ill recipient is mentally or physically incapacitated.

    Palliative Care: Care affording relief, but not cure. Providing an alleviating medicine and managing the symptoms experienced by the hospice recipient. The intent is to enhance the quality of life for the hospice recipient and his or her family, but is not directed at curing the disease.

    Respite Care: Short-term inpatient care provided to the recipient only when necessary to relieve the family members or other persons caring for the recipient.

    Social Worker: A person who has at least a bachelor's degree in social work from a program accredited or approved by the Council on Social Work Education and who complies with the Minnesota statues related to social work licensure.

    Terminally Ill: A medical prognosis with a life expectancy of six months or less, given that the terminal illness runs its normal course.

    Legal References

    Minnesota Statue – 256B.0625 subd. 22 – Covered Services – Hospice Care
    Minnesota Rules - 9505.0297
    - Hospice Care Services
    Minnesota Rules - 9505.0446
    - Hospice Care Payment Rates & Procedures
    Balanced Budget Act of 1997

    42 CFR 1396a

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