These services may or may not be covered by all HealthPartners plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
- Respite care
- Continuous care
- Inpatient Services related to Acute Symptom Management of Terminal Illness
Prior notification is required for home visits (0-2 hours) related to hospice treatment while members are enrolled in Hospice.
Prior authorization is not required for the following:
- Medically necessary Durable Medical Equipment (DME),
- Formula or supplements such as Ensure when it is the sole source of nutrition
- Disposable supplies
- Office visits
An MA/MinnesotaCare recipient:
- Must be certified as terminally ill to be eligible for MA coverage of hospice care.
- May receive hospice care until they are no longer certified as terminally ill or until the recipient or representative revokes the election of hospice.
Recipient Election of Hospice
MA recipients who are also covered by Medicare should elect Medicare hospice coverage as well as coverage through MA.
Home hospice services are generally covered subject to the indications below.
The following services are covered and must be provided directly by hospice employees or made available by the hospice:
- Nursing services provided by or under the supervision of a registered nurse.
- Medical social services provided by a social worker under the direction of a physician.
- Services performed by a physician, nurse or other professionals.
- Counseling services provided to the terminally ill recipient and the family members or other persons caring for the recipient at the recipient's home. Counseling, including dietary counseling, may be provided to train the recipient's family or other caregivers to provide care and to help the recipient and those caring for them adjust to the recipient's approaching death.
- The hospice must make bereavement services available to the recipient's family for one year after the recipient's death. The family includes persons related to the recipient or those considered by the recipient to be family because of their close association.
Note: The Balanced Budget Act (BBA) of 1997:
- Deleted physician services from a hospice's care services and allows hospices to employ or contract with physicians for their services.
- Indicates that the dietary counseling requirement may be waived in non-urbanized areas after diligent efforts by the hospice to recruit appropriate personnel have been made.
- Inpatient hospice care including services necessary for pain control or acute or chronic symptom management. Inpatient hospice care is provided in a Medicare or MA certified hospital, a skilled nursing facility, an inpatient hospice unit, or a MA certified intermediate care facility.
- Up to five days of respite care to provide respite for the recipient's family or other persons caring for the recipient at home. Inpatient respite care is provided in a Medicare or MA certified hospital, a skilled nursing facility, an inpatient hospice unit, or a MA certified intermediate care facility.
- Durable Medical Equipment (DME) and supplies. Medical appliances, DME, are included, as well as other self help and personal comfort items related to the palliation or management of the recipient's terminal illness. Medical supplies include those specified in the written plan of care.
- Drugs used primarily to relieve pain and control symptoms for the recipient's terminal illness.
- Home health aide services and homemaker services. Home health aides may provide personal care services. Home health aides and homemakers may perform household services to maintain a safe and sanitary environment in areas of the home used by the recipient. Examples of household services are changing the recipient's bed linens or light cleaning and laundering essential to the comfort and cleanliness of the recipient. Home health aide services must be provided under the supervision of a registered nurse.
- Physical therapy, occupational therapy, and speech/language pathology services provided to maintain activities of daily living and basic functional skills.
- Services during a crisis: A hospice may provide nursing services, including homemaker or home health aide services, to a recipient on a continuous basis for as much as 24 hours a day during a crisis as necessary to maintain the recipient at home. More than half of the care during the crisis must be nursing care provided by a registered nurse or licensed practical nurse. A crisis is a period during which the recipient requires continuous care for palliation or management of acute medical symptoms.
This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.
Portions of the contents of these coverage criteria relating to Minnesota Public Programs medical coverage criteria are taken directly from the Minnesota Health Care Programs Provider Manual at http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_008997
Minnesota Administrative Rules, Human Services Department, Chapter 9505, Part: 9505.0297 Hospice Care Services at https://www.revisor.mn.gov/rules/?id=9505.0297