CAM 233

Hospice Care

Category:Other   Last Reviewed:March 2020
Department(s):Medical Affairs   Next Review:March 2021
Original Date:March 1995    

Description:
Hospice care is a multidisciplinary service that provides end-of-life care including home nursing visits, physicians’ services, available on call, teaching and emotional support for the family and palliative care of the client.  It is a system of family-centered care designed to assist the terminally ill person to be comfortable and to maintain maximum comfort through the final stages of life.

Hospice services are usually provided in the client’s home or in the home of a family member.  In general, hospice services are not available to clients who are inpatients in hospital or nursing home facilities.

Policy:
The following criteria must be met in order to receive coverage benefits for hospice care:

  • Attending physician must certify that client is terminally ill and, with reasonable medical certainty, is not expected to live more than an additional 6 months.
  • All services must receive prior approval, and the request must provide at a minimum the following:
    1. name of attending/certifying physician
    2. client’s diagnosis and summary of client’s clinical condition and expected course
    3. summary of services that are expected to be rendered to the client

Policy Statement:
Hospice care is a multidisciplinary service that provides home nursing visits, physicians’ services, available on call, teaching and emotional support for the family and physical care of the client.  It is a system of family-centered care designed to assist the chronically ill person to be comfortable and to maintain maximum comfort through the final stages of terminal illness.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

03/03/2020 

Annual review, no change to policy intent. 

03/01/2019 

Annual review, no change to policy intent. 

03/05/2018 

Annual review, no change to policy intent. 

03/01/2017 

Annual review, no change to policy intent. 

06/27/2016 

Make external to follow internal policy.

03/01/2016 

Annual review, no change to policy intent. 

03/16/2015 

Annual review, no changes to policy.

03/4/2014

Annual review. No changes made.

 


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