(1) The medicaid agency reimburses a hospice agency for providing covered services, including core services and supplies described in this section, through the medicaid agency's hospice daily rate, subject to the conditions and limitations described in this section and other WAC. See WAC 182-551-1860
for pediatric concurrent care.
(2) To qualify for reimbursement, covered services, including core services and supplies in the hospice daily rate, must be:
(a) Related to the client's hospice diagnosis;
(b) Identified by the client's hospice interdisciplinary team;
(c) Written in the client's plan of care (POC); and
(d) Made available to the client by the hospice agency on a twenty-four hour basis.
(3) The hospice daily rate includes the following core services that must be either provided by hospice agency staff, or contracted through a hospice agency, if necessary, to supplement hospice staff in order to meet the needs of a client during a period of peak patient loads or under extraordinary circumstances:
(a) Physician services related to the administration of POC.
(b) Nursing care provided by:
(i) A registered nurse (RN); or
(ii) A licensed practical nurse (LPN) under the supervision of an RN.
(c) Medical social services provided by a social worker under the direction of a physician.
(d) Counseling services provided to a client and the client's family members or caregivers.
(4) Covered services and supplies may be provided by a service organization or an individual provider when contracted through a hospice agency. To be reimbursed the hospice daily rate, a hospice agency must:
(a) Assure all contracted staff meets the regulatory qualification requirements;
(b) Have a written agreement with the service organization or individual providing the services and supplies; and
(c) Maintain professional, financial, and administrative responsibility.
(5) The following covered services and supplies are included in the appropriate hospice daily rate as described in WAC 182-551-1510
(6), subject to the conditions and limitations described in this section and other WAC:
(a) Skilled nursing care;
(b) Drugs, biologicals, and over-the-counter medications used for the relief of pain and symptom control of a client's terminal illness and related conditions;
(c) Communication with nonhospice providers about care not related to the client's terminal illness to ensure the client's plan of care needs are met and not compromised;
(d) Durable medical equipment and related supplies, prosthetics, orthotics, medical supplies, related services, or related repairs and labor charges in accordance with WAC 182-543-9100
(6)(c). These services and equipment are paid by the hospice agency for the palliation and management of a client's terminal illness and related conditions and are included in the daily hospice rate;
(e) Hospice aide, homemaker, and/or personal care services that are ordered by a client's physician and documented in the POC. (Hospice aide services are provided through the hospice agency to meet a client's extensive needs due to the client's terminal illness. These services must be provided by a qualified hospice aide and are an extension of skilled nursing or therapy services. See 42 C.F.R. 484.36);
(f) Physical therapy, occupational therapy, and speech-language therapy to manage symptoms or enable a client to safely perform ADLs (activities of daily living) and basic functional skills;
(g) Medical transportation services, including ambulance (see WAC 182-546-5550
(h) A brief period of inpatient care, for general or respite care provided in a medicare-certified hospice care center, hospital, or nursing facility; and
(i) Other services or supplies that are documented as necessary for the palliation and management of a client's terminal illness and related conditions;
(6) A hospice agency is responsible to determine if a nursing facility has requested authorization for medical supplies or medical equipment, including wheelchairs, for a client who becomes eligible for the hospice program. The medicaid agency does not pay separately for medical equipment or supplies that were previously authorized by the medicaid agency and delivered on or after the date the medicaid agency enrolls the client in the hospice program.
[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. WSR 12-09-079, § 182-551-1210, filed 4/17/12, effective 5/18/12. WSR 11-14-075, recodified as § 182-551-1210, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090
. WSR 05-18-033, § 388-551-1210, filed 8/30/05, effective 10/1/05. Statutory Authority: RCW 74.09.520
, 42 C.F.R. 418.22 and 418.24. WSR 99-09-007, § 388-551-1210, filed 4/9/99, effective 5/10/99.]