HOSPICE CARE SERVICES. The Plan provides Benefits for Hospice Care to Members diagnosed as having a terminal illness by a Provider with a life expectancy of less than twelve months. The Hospice plan of care will focus on palliative rather than curative treatment for the terminally ill Member. The care approach is holistic and interdisciplinary. Your Provider and hospice medical director must certify that you are terminally ill and likely have less than twelve months to live. Your Provider must agree to care by the hospice Provider and must be consulted in the development of the care plan. The hospice Provider must keep a written care plan and provide it to Health Options upon request.
HOSPICE CARE SERVICES. See the Prior Authorization Amendment for Covered Services that may require prior authorization.
HOSPICE CARE SERVICES. Services rendered by a Home Health Care Agency or a Hospital program for Hospice Care for which benefits are available as follows:
1. Skilled Nursing Services of a Registered Nurse (RN) or Licensed Practical Nurse (LPN);
2. Physical Medicine, Speech Therapy and Occupational Therapy Services;
3. Medical and surgical supplies provided by the Home Health Care Agency or Hospital Program for Hospice Care;
4. Oxygen and its administration;
5. Medical social service consultations;
6. Health aide Services to a Member who is receiving covered nursing Services or Habilitative and Rehabilitative Services or Therapy Services;
7. Family Counseling related to the Member’s terminal condition; and
8. Respite Care; and
9. Hospice Care Services will be provided to Members with a life expectancy of one hundred eighty (180) days or less, as certified by a Physician.
10. No Hospice Care benefits will be provided for:
a. Dietitian Services;
b. Homemaker Services;
c. Maintenance therapy;
d. Dialysis treatment;
e. Custodial Care; and
f. Food or home delivered meals.
HOSPICE CARE SERVICES. See Section 15, Utilization Management, for Covered Services that require prior authorization.
HOSPICE CARE SERVICES. Hospice Care Services are for terminally ill Members. If a Plan Physician diagnoses you with a terminal illness and determines that your life expectancy is six (6) months or less, you can choose hospice Services through home or inpatient care instead of traditional Services otherwise provided for your illness. We cover Hospice Care Services in the home if a Plan Physician determines that it is feasible to maintain effective supervision and control of your care in your home. We cover Hospice Care Services within our Service Area and only when provided by a Plan Provider. Hospice Services include the following:
1. Nursing care;
2. Physical, occupational, speech and respiratory therapy;
3. Medical social Services;
4. Home health aide Services;
HOSPICE CARE SERVICES. Services rendered by a Home Health Care Agency or a Hospital program for Hospice Care for which benefits are available as follows:
1. Skilled Nursing Services of a Registered Nurse (RN) or Licensed Practical Nurse (LPN)*;
2. Physical Medicine, Speech Therapy and Occupational Therapy Services; The services of a Licensed Practical Nurse (LPN) shall be made available only when the services of a Registered Nurse are not available and only when Medically Necessary and Appropriate. Services of a LPN are only reimbursable through a Facility Provider.
3. Medical and surgical supplies provided by the Home Health Care Agency or Hospital Program for Hospice Care;
4. Oxygen and its administration;
5. Medical social service consultations;
6. Health aide Services to a Member who is receiving covered nursing Services or Habilitative and Rehabilitative Services or Therapy Services;
7. Respite Care;
8. Family Counseling related to the Member’s terminal condition; and
9. Hospice Care Services will be provided to Members with a life expectancy of one hundred eighty (180) days or less, as certified by a Physician.
10. No Hospice Care benefits will be provided for:
a. Dietitian Services;
b. Homemaker Services;
c. Maintenance therapy;
d. Dialysis treatment;
e. Custodial Care; and
f. Food or home delivered meals.
HOSPICE CARE SERVICES. If You become Terminally Ill and You receive care provided by a Hospice, We will pay: The Eligible Charges of the Hospice; up to The Home and Community-Based Care Monthly Maximum amount for each calendar month of care. Provided that You meet all of the requirements of the Eligibility For The Payment Of Benefits provision of the Policy. The Elimination Period does not apply to this Benefit, and the days on which We pay benefits under this Benefit do not count toward satisfying the Elimination Period. Any amounts We pay for Hospice Care will count toward the Policy Lifetime Maximum Benefit.
HOSPICE CARE SERVICES. WHERE CAREFIRST BLUECHOICE PROVIDES MEMBER PAYS HOSPICE CARE SERVICES MUST BE AUTHORIZED OR APPROVED BY CAREFIRST BLUECHOICE
A. Intermittent nursing care by or under the direction of a registered nurse.
B. Medical social services for the terminally ill patient and his or her Immediate Family. Immediate Family means the patient's spouse, parents, siblings, grandparents, and children.
X. Xxxxxxxxxx, including dietary counseling, for the terminally ill Member.
D. Non-Custodial home health visits.
E. Services, visits, medical/surgical equipment or supplies; including equipment and medication required to maintain the comfort and manage the pain of the terminally ill Member.
F. Laboratory Tests and X-Ray Services.
G. Ambulance services, when Medically Necessary as determined by CareFirst BlueChoice.
H. Respite Care will be limited to 14 days per Hospice Eligibility Period. Respite Care means temporary care provided to the terminally ill Member to relieve the Family Caregiver from the daily care of the Member.
I. Home visits within the Service Area.
X. Xxxxxxxxx care is limited to a lifetime maximum of thirty (30) days per Member.
K. Family Counseling will be provided for the Immediate Family and Family Caregiver before the death of the terminally ill Member when authorized or approved by CareFirst BlueChoice. Family Counseling means counseling given to the Immediate Family or Family Caregiver of the terminally ill Member for the purpose of learning to care for the Member and to adjust to the death of the Member. Family Caregiver means a relative by blood, marriage, or adoption who lives with or is the primary caregiver of the terminally ill Member.
X. Xxxxxxxxxxx Services will be provided for the Immediate Family or Family Caregiver of the Member for the six (6) month period following the Member's death or fifteen (15) visits, whichever occurs first. Bereavement Counseling means counseling provided to the Immediate Family or Family Caregiver of the Member after the member's death to help the Immediate Family or Family Caregiver cope with the Member's death.
HOSPICE CARE SERVICES. The Plan provides Benefits for Hospice Care to Members diagnosed as hav ing a terminal illness by a Provider with a life expectancy of less than twelve months. The Hospice plan of care will focus on palliative rather than curative treatment for the terminally ill Member. The care approach is holistic and interdisciplinary. Yo ur Provider and hospice medical director must certify that you are terminally ill and likely have less than twelve months to live. Your Provider must agree to care by the hospice Provider and must be consulted in the development of the care plan. The hos pice Provider must keep a written care plan and provide it to Health Options upon request.
HOSPICE CARE SERVICES. For the purpose of this Benefit, "hospice care services" means the following items and services provided to a terminally ill Covered Person by, or by others under arrangement made by a Hospice Program under a written plan (for providing such care to such Covered Person) established and periodically reviewed by the Covered Person's attending Physician and by the Medical Director.
1. Nursing care provided by or under the supervision of a registered professional nurse;
2. Physical or occupational therapy or speech-language pathology;
3. Medical social services under the direction of a Physician;
4. Services of a home health aide and homemaker services;
5. Medical supplies, including drugs and biologicals, and the use of medical appliances;
6. Physician services;
7. Short-term inpatient care, including both respite care and procedures necessary for pain control and acute and chronic system management, in an inpatient facility, but such respite care may be provided only on an intermittent, non-routine and occasional basis and may not be provided consecutively over longer than five (5) days;
8. Counseling, including dietary counseling, with respect to care of the terminally ill Covered Person and adjustment to his or her death. The care and services described above in numbers (1) and (4) above may be provided on a twenty-four
