Current through September 2, 2024
Section 16.03.10.451 - HOSPICE: DEFINITIONSThe following definitions apply to Sections 450 through 456 of these rules.
01.Attending Physician. A physician who:a. Is a doctor of medicine or osteopathy; andb. Is identified by the participant, at the time they elect to receive hospice care, as having the most significant role in the determination and delivery of the participant's medical care.02.Benefit Period. A period of time that begins on the first day of the month the participant elects hospice and ends on the last day of the eleventh successive calendar month.03.Bereavement Counseling. Counseling services provided to the participant's family after the participant's death.04.Cap Amount. The maximum amount of reimbursement the Idaho Medicaid Program will pay a designated hospice for providing services to Medicaid participants per Section 459 of these rules.05.Cap Period. The twelve (12) month period beginning November 1 and ending October 31 of the next year. See overall hospice reimbursement cap referred to in Section 459 of these rules.06.Election Period. One (1) of eight (8) periods within the benefit period that an participant may elect to receive Medicaid coverage of hospice care. Each period consists of any calendar month, or portion thereof, chosen within the benefit period.07.Employee. An individual serving the hospice or, if the hospice is a subdivision of an agency or organization, an employee of the agency or organization that is appropriately trained and assigned to the hospice unit. Employee also refers to a volunteer under the jurisdiction of the hospice.08.Freestanding Hospice. A hospice that is not part of any other type of participating provider.09.Hospice. A public agency or private organization or a subdivision that:a. Is primarily engaged in providing care to terminally ill participants; andb. Meets the conditions specified for certification for participation in the Medicare and Medicaid programs and has a valid provider agreement.10.Independent Physician. An attending physician who is not an employee of the hospice.11.Representative. A person who is, because of the participant's mental or physical incapacity, legally authorized in accordance with state law to execute or revoke an election for hospice care or terminate medical care on behalf of the terminally ill participant.12.Social Worker. A person who has at least a bachelor's degree from a school accredited or approved by the Council on Social Work Education.13.Terminally Ill. When a participant has a certified medical prognosis that life expectancy is six (6) months or less per Subsection 454.01 of these rules.Idaho Admin. Code r. 16.03.10.451