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Provider Manual

Hospice Protocols

Last Updated on January 24, 2019

Security Health Plan follows Hospice Policy for hospice services.. The per diems for these codes are all-inclusive. View prior authorization form.

    • Have coverage in their policy for the inpatient hospice benefit requested

Covered expenses

Facility

  • Covered expenses billed on its own behalf by a hospice provider, hospital or convalescent facility. Expenses include room and board and other services and supplies furnished while the member is a full-time inpatient for pain control and other acute and chronic symptom management. This includes room and board charges for hospice services provided in a certified inpatient hospital hospice or skilled nursing facility hospice.

Home care

  • Services and supplies furnished to the member while not confined on a full-time basis.
  • Part-time or intermittent nursing care by a registered nurse or licensed practical nurse for up to eight hours in any one day.
  • Medical social services under the direction of a physician. These include assessment of social, emotional and medical needs, the home and family situation, and identification of community resources that are available and assisting the member in obtaining these resources.
  • Psychological and dietary counseling.
  • Consultation or case management services by a physician.
  • Part-time or intermittent home health aide services for up to 8 hours in any one day to assist with care of the member.
  • Medical supplies prescribed by a physician. Drugs and medicine are covered only while a member is confined to a hospice facility. Groups or individuals with no prescription drug benefit only have coverage for medications that are billed under the hospice per diem. Medications billed as a ‘line item’ that are generally self-administered or obtained through a pharmacy benefit, are not eligible for coverage.
  • Covered expenses for services of the following providers, but only if the provider is an employee of a hospice care agency and such agency retains responsibility for the member’s care: – Physician for consultation or case management services. – Physical or occupational therapy.

Hospice exclusions

  • Pastoral counseling
  • Financial or legal counseling
  • Homemaker or caretaker services and any service or supply not solely related to the care of the member, including, but not limited to, sitter or companion services for the member who is ill or other members of the family, transportation, house cleaning, and maintenance of the house
  • Respite care – this is care provided during a period of time when the member’s family or usual caretaker cannot or will not attend to the person’s needs
  • Free standing respite care facility (example – House of the Dove) room and board charges are not covered however, the per diem charge for the hospice provider is covered
  • Funeral arrangements

Security Health Plan will (upon request from the Hospice care provider) verify member benefits for the hospice provider, assess the necessity of hospice care and authorize covered expenses.

Hospice provider will review the case telephonically with a Security Health Plan utilization review nurse (or his/her designee) upon Security Health Plan request

To request a full version copy of a specific Security Health Plan Medical policy, call 1-800-548-1224 ext. 19671.