A. As used in this act, "hospice care" means a comprehensive, holistic program of palliative and/or comfort care and support provided to the member and his or her family when a physician certifies that the member has a terminal illness and has a life expectancy of six (6) months or less. 1. Hospice services must be related to the palliation and management of the member's illness, symptom control, or to enable the individual to maintain activities of daily living and basic functional skills; and 2. Hospice care is performed under the direction of a physician as per the member's plan of care in an approved hospital hospice facility, in-home hospice program, or nursing facility. B. 1. Coverage for hospice services shall be provided to all Medicaid eligible members. 2. Hospice care eligibility requires physician certification that the member is terminally ill and includes a medical prognosis with a life expectancy of six (6) months or less if the illness runs its normal course. The terminal prognosis also must be supported by clinical documentation in the medical record.
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