Program Operations Manual System (POMS)
HI 00601.290 Covered Hospice Services
The following services are covered hospice services:
Nursing care provided by or under the supervision of a registered nurse.
Medical social services provided by a social worker who is working under the direction of a physician.
Physicians' services performed by a physician (as defined in 42 CFR 405.232a) except that the services of the hospice medical director or the physician member of the hospice's interdisciplinary group that provides or supervises the hospice's services must be performed by a doctor of medicine or osteopathy.
Counseling services provided to the terminally ill individual and the family members or other persons caring for the individual at home. Counseling, including dietary counseling, may be provided both for the purpose of training the individual's family or other care-giver to provide care, and for the purpose of helping the individual and those caring for him or her to adjust to the individual's approaching death.
Short-term inpatient care provided in a participating hospice inpatient unit, or in a participating hospital, SNF, or intermediate care facility (ICF) that additionally meets the special hospice standards regarding staffing and patient areas. Services provided in an inpatient setting must conform to the written plan of care. General inpatient care may be required for procedures necessary for pain control or acute or chronic symptom management which cannot be provided in other settings. Inpatient care may also be furnished to provide respite for the individual's family or other persons caring for the individual at home. Respite care is the only type of inpatient care that may be provided in an ICF.
NOTE: Hospice inpatient care, other than respite care in an ICF, will interrupt the generation of a new benefit period for general Medicare hospital and SNF benefits. This would have potential effect on patients who revoke or exhaust the hospice benefit. (See HI 00601.295.)
Medical appliances and supplies, including drugs and biologicals. Only drugs as defined in 1861(t) of the Act and which are used primarily for the relief of pain and symptom control related to the individual's terminal illness are covered. Appliances may include covered durable medical equipment as described in 42 CFR 405.231(g) as well as other self-help and personal comfort items related to the palliation or management of the patient's terminal illness. Equipment is provided by the hospice for use in the patient's home while he or she is under hospice care. Medical supplies include those that are part of the written plan of care.
Home health aide services furnished by qualified aides and homemaker services. Home health aides may provide personal care services. Aides may also perform household services to maintain a safe and sanitary environment in areas of the home used by the patient, such as changing the bed or light cleaning and laundering essential to the comfort and cleanliness of the patient. Aide services must be provided under the general supervision of a registered nurse. Homemaker services may include assistance in personal care, maintenance of a safe and healthy environment, and services to enable the individual to carry out the plan of care.
Physical therapy, occupational therapy and speech-language pathology services provided for purposes of symptom control or to enable the individual to maintain activities of daily living and basic functional skills.
Nursing care, physicians' services, medical social services and counseling are core hospice services and must routinely be provided directly by hospice employees. Supplemental services may be contracted for during periods of peak patient loads and to obtain physician specialty services.