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016.06.36-203.160. Physician's Role in the Hospice Program.

AR ADC 016.06.36-203.160Arkansas Administrative Code

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 36. Physician/Independent Lab/Crna/Radiation Therapy Center Provider Manual (Refs & Annos)
Section 203.000. Physician's Role in the Medicaid Program.
Ark. Admin. Code 016.06.36-203.160
016.06.36-203.160. Physician's Role in the Hospice Program.
Currentness
Hospice is a continuum of care, directed by professionals, designed to optimize the comfort and functionality of terminally ill patients for whom curative medicine has exhausted its possibilities. Hospice emphasizes relief from distress for the patient without actively shortening or prolonging life. Relief from distress includes palliation of physical, psychological and psychosocial symptoms of distress and a regular regime for alleviation of physical pain. All efforts are directed to the enrichment of living during the final days of life and to the provision of ongoing opportunities for the patient to be involved in life.
The physician prescribing hospice care must be the recipient's primary care physician (PCP) unless the recipient is exempt from PCP requirements.
Hospice services are defined as reasonable and medically necessary services, palliative and supportive in nature, provided to the terminally ill, for the management of the terminal illness and related conditions.
The hospice patient must be terminally ill which is defined as having a medical prognosis with a life expectancy of six months or less. Patients who elect to receive hospice services must receive hospice services instead of certain other Medicaid benefits.
A. Hospices must ensure that patients receive the following physician services as needed:
1. Direct care related to the palliation and management of the patient's terminal illness and
2. Care for the hospice patient's general medical needs.
B. Hospice physicians must provide such services to the extent that the patient's attending physician does not provide them.
1. A patient's attending physician may bill Medicaid on a fee-for-service basis unless the physician is a “hospice physician,” defined as providing the care:
a. As an employee of the hospice,
b. Under an arrangement with the hospice or
c. As a volunteer.
2. Hospice physicians may bill Medicaid on a fee-for-service basis, subject to the following conditions:
a. Each hospice whose physicians provide any direct patient care to the hospice's patients on a fee-for-service basis must enroll with Medicaid as a physician-billing intermediary. See Section 201.111 and Section 1 of this manual for participation requirements and enrollment materials.
b. Each of the hospice's physicians providing patient care for which the hospice or the physician claims Medicaid reimbursement in addition to the hospice daily rate, must authorize the hospice to bill for that care as the physician's billing intermediary. See Section 201.111 and Section I of this manual for participation requirements and enrollment materials.
c. Medicaid does not reimburse hospices for donated physician services.

Credits

Eff. Oct. 13, 2003.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.36-203.160, AR ADC 016.06.36-203.160
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