All services, supplies and equipment related to the client's terminal illness and related conditions are included in the hospice daily rate. The medicaid agency pays for only one of the following four levels of hospice care per day (see WAC 182-551-1510
for payment methods):
(1) Routine home care. Routine home care includes daily care administered to the client at the client's residence. The services are not restricted in length or frequency of visits, are dependent on the client's needs, and are provided to achieve palliation or management of acute symptoms.
(2) Continuous home care. Continuous home care includes acute skilled care provided to an unstable client during a brief period of medical crisis to maintain the client in the client's residence and is limited to:
(a) A minimum of eight hours of acute care provided during a twenty-four-hour day;
(b) Nursing care that must be provided by a registered or licensed practical nurse for more than half the period of care;
(c) Homemaker, hospice aide, and attendant services that may be provided as supplements to the nursing care; and
(d) In home care only (not care in a nursing facility or a hospice care center).
(3) Inpatient respite care. Inpatient respite care includes room and board services provided to a client in a medicaid-approved hospice care center, nursing facility, or hospital. Respite care is intended to provide relief to the client's primary caregiver and is limited to:
(a) No more than six consecutive days; and
(b) A client not currently residing in a hospice care center, nursing facility, or hospital.
(4) General inpatient hospice care. General inpatient hospice care includes services administered to a client for pain control or management of acute symptoms. In addition:
(a) The services must conform to the client's written plan of care (POC).
(b) This benefit is limited to brief periods of care in medicaid agency-approved:
(ii) Nursing facilities; or
(iii) Hospice care centers.
(c) There must be documentation in the client's medical record to support the need for general inpatient level of hospice care.
[Statutory Authority: RCW 41.05.021
. WSR 16-03-035, § 182-551-1500, filed 1/12/16, effective 2/12/16. 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, § 182-551-1500, filed 4/17/12, effective 5/18/12. WSR 11-14-075, recodified as § 182-551-1500, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090
. WSR 05-18-033, § 388-551-1500, 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, § 388-551-1500, filed 4/9/99, effective 5/10/99.]