BIOETYKA / ETYKA MEDYCZNA

BIOETYKA / ETYKA MEDYCZNA - Przeglądy aktów prawnych

Hospice Mediacare & Medicaid Regulations – Code of Federal Regulation rozdział IV

§418.3   Definitions.

Hospice means a public agency or private organization or subdivision of either of these that is primarily engaged in providing hospice care as defined in this section.

Hospice care means a comprehensive set of services described in 1861(dd)(1) of the Act, identified and coordinated by an interdisciplinary group to provide for the physical, psychosocial, spiritual, and emotional needs of a terminally ill patient and/or family members, as delineated in a specific patient plan of care.

Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.

§418.20   Eligibility requirements.

In order to be eligible to elect hospice care under Medicare, an individual must be—

1. Entitled to Part A of Medicare; and
2. Certified as being terminally ill in accordance with §418.22.

§418.24   Election of hospice care.

1. Filing an election statement. An individual who meets the eligibility requirement of §418.20 may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her representative (as defined in §418.3) may file the election statement.

§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:

1. Nursing care provided by or under the supervision of a registered nurse (…).
2. Medical social services provided by a social worker under the direction of a physician (…).
3. Physicians' services (…).
4. Counseling services (…).
5. Short-term inpatient care (…).
6. Medical appliances and supplies, including drugs and biological (…).
7. Home health or hospice aide services (…).
8. Physical therapy, occupational therapy and speech-language pathology services (…).

§418.400   Individual liability for coinsurance for hospice care.

An individual who has filed an election for hospice care in accordance with §418.24 is liable for the following coinsurance payments. Hospices may charge individuals the applicable coinsurance amounts.

1. Drugs and biologicals. An individual is liable for a coinsurance payment for each palliative drug and biological prescription furnished by the hospice while the individual is not an inpatient. The amount of coinsurance for each prescription approximates 5 percent of the cost of the drug or biological to the hospice determined in accordance with the drug copayment schedule established by the hospice, except that the amount of coinsurance for each prescription may not exceed $5. The cost of the drug or biological may not exceed what a prudent buyer would pay in similar circumstances. The drug copayment schedule must be reviewed for reasonableness and approved by the intermediary before it is used.
2. Respite care. (1) The amount of coinsurance for each respite care day is equal to 5 percent of the payment made by CMS for a respite care day. (2) The amount of the individual's coinsurance liability for respite care during a hospice coinsurance period may not exceed the inpatient hospital deductible applicable for the year in which the hospice coinsurance period began. (…)