This Policy does not apply to FEP
Precertification is required for all Hospice admissions. The Member’s Benefit Plan language is the primary determinant of coverage.
General Inpatient Hospice care falls under the Member’s available Hospice Benefit, not the Member’s Inpatient Hospital Benefit.
Where permitted under the Provider agreement, initial admissions or additional days performed without preauthorization approval and on review of clinical documentation are determined by BCBSND to not meet criteria in this policy will be denied as provider-liable.
Please refer to the Member’s Plan Book for definitions.
Hospice – an organization that provides medical, social and psychological services in the home or inpatient facility as palliative treatment for individuals with a terminal illness and life expectancy of less than 6 months.
For purposes of this policy, coverage, and reimbursement, the following levels of Hospice care are considered:
- Routine Home Care (HRH)
- Continuous Home Care (HCH)
- Respite Home Care (HRC)
- Inpatient Respite Care (HIR)
- General Inpatient Care (HGI)
Various core services provided by Hospice, based on the individual member’s needs include:
- Skilled nursing
- Social worker
- Pastoral care
- PT/OT/Speech therapy/respiratory therapy
- Home health aide
- Medical equipment
- Drugs and biologicals for the palliation and management of pain and symptoms of the terminal illness and related conditions
- Dietary counseling
- Volunteer coordination
- Bereavement counseling