Homecare & HospiceHospiceEligibility & Coverage

Eligibility Requirements and Insurance Coverage for Hospice

This information is based on the Medicare Hospice Benefit. Private insurance benefits may vary. Contact the Intermountain Homecare nearest you to review insurance coverage.

Established in 1983, the Medicare Hospice Benefit (MHB) pays for medical, nursing, counseling, and bereavement services to terminally ill patients and their families. The original goal of the MHB was to support families caring for their dying relative at home. Under certain circumstances, hospice services under the MHB can also be provided in a nursing home or the acute care hospital. Referral for hospice care is appropriate when the overall plan of care is directed toward comfort rather than reversing the underlying disease process.

Eligibility-Medicare Hospice Benefit

  • The patient must elect the Medicare Hospice Benefit. Services for health conditions not related to the hospice diagnoses are still covered under Medicare A&B.
  • The patient must be certified by the Hospice Medical Director and attending physician, to have a life expectancy of six months or less, if the disease runs its natural course. Patients can continue to be eligible if they live beyond 6 months as long as the physicians believe death is likely within 6 months.
  • Do Not Resuscitate (DNR) status is not used as a requirement for admission.

Covered Services (100% coverage with no co-pay)

  • Care plan oversight by the Hospice Medical Director.
  • Nursing care: symptom assessment, skilled services/treatments and case management. The nurse visits routinely; 24-hour/7-day per week emergency care is available.
  • Social work: patient and family counseling, emotional support and end-of-life planning (advanced directives).
  • Chaplain services: spiritual support for patients and families.
  • All medications and supplies related to the terminal illness. The hospice may charge a $5 co-pay per prescription, but Intermountain Homecare chooses not to. Medications for conditions not related to the terminal condition are not covered.
  • Durable medical equipment: hospital bed, commode, wheelchair, etc.
  • Home health aide and homemaker services.
  • Speech therapy, nutrition, PT, and OT services as determined by the Plan of Care (see below).
  • Bereavement support to family for one year after the patient's death.
  • Short term general inpatient care for problems that cannot be managed at home, most commonly intractable pain or unrelieved symptoms.
  • Short term inpatient respite care: up to 5 days to permit family caregivers to take a break.
  • Continuous care at home for short episodes of acute need.

Plan of Care (POC)

The hospice team and the patient's attending physician work together to maximize quality of life, by jointly developing a Plan of Care. The POC is based on the patient's diagnosis, symptoms and other needs. The hospice program and the patient's physician must approve any proposed tests, treatments, and services. In general, those treatments which are necessary for symptom or pain management will be approved.

Physician Role

At the time of enrollment the patient chooses an attending physician who may be their primary care physician, a specialist or the Hospice Medical Director. This physician is responsible for working with the hospice team to determine appropriate care. The Hospice Medical Director is available for consultation and backup coverage.

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