[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR418.202]



[Page 926-927]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 418_HOSPICE CARE--Table of Contents

 

                       Subpart F_Covered Services

 

Sec. 418.202  Covered services.



    All services must be performed by appropriately qualified personnel, 

but it is the nature of the service, rather than the qualification of 

the person who provides it, that determines the coverage category of the 

service. The following services are covered hospice services:

    (a) Nursing care provided by or under the supervision of a 

registered nurse.

    (b) Medical social services provided by a social worker under the 

direction of a physician.

    (c) Physicians' services performed by a physician as defined in 

Sec. 410.20 of this chapter except that the services of the hospice 

medical director or the physician member of the interdisciplinary group 

must be performed by a doctor of medicine or osteopathy.

    (d) Counseling services provided to the terminally ill individual 

and the family members or other persons caring for the individual at 

home. Counseling, including dietary counseling, may be provided both for 

the purpose of training the individual's family or other caregiver to 

provide care, and for the purpose of helping the individual and those 

caring for him or her to adjust to the individual's approaching death.

    (e) Short-term inpatient care provided in a participating hospice 

inpatient unit, or a participating hospital or SNF, that additionally 

meets the standards in Sec. 418.202 (a) and (e) regarding staffing and 

patient areas. Services provided in an inpatient setting must conform to 

the written plan of care. Inpatient care may be required for procedures 

necessary for pain control or acute or chronic symptom management.



Inpatient care may also be furnished as a means of providing respite for 

the individual's family or other persons caring for the individual at 

home. Respite care must be furnished as specified in Sec. 418.98(b). 

Payment for inpatient care will be made at the rate appropriate to the 

level of care as specified in Sec. 418.302.

    (f) Medical appliances and supplies, including drugs and 

biologicals. Only drugs as defined in section 1861(t) of the Act and 

which are used primarily



[[Page 927]]



for the relief of pain and symptom control related to the individual's 

terminal illness are covered. Appliances may include covered durable 

medical equipment as described in Sec. 410.38 of this chapter as well 

as other self-help and personal comfort items related to the palliation 

or management of the patient's terminal illness. Equipment is provided 

by the hospice for use in the patient's home while he or she is under 

hospice care. Medical supplies include those that are part of the 

written plan of care.

    (g) Home health aide services furnished by qualified aides as 

designated in Sec. 418.94 and homemaker services. Home health aides may 

provide personal care services as defined in Sec. 409.45(b) of this 

chapter. Aides may perform household services to maintain a safe and 

sanitary environment in areas of the home used by the patient, such as 

changing bed linens or light cleaning and laundering essential to the 

comfort and cleanliness of the patient. Aide services must be provided 

under the general supervision of a registered nurse. Homemaker services 

may include assistance in maintenance of a safe and healthy environment 

and services to enable the individual to carry out the treatment plan.

    (h) Physical therapy, occupational therapy and speech-language 

pathology services in addition to the services described in Sec. 409.33 

(b) and (c) of this chapter provided for purposes of symptom control or 

to enable the patient to maintain activities of daily living and basic 

functional skills.



[48 FR 56026, Dec. 16, 1983, as amended at 51 FR 41351, Nov. 14, 1986; 

55 FR 50835, Dec. 11, 1990; 59 FR 65498, Dec. 20, 1994]