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(1) To be covered, hospice services must meet the following requirements:

(a) they must be reasonable and necessary for the palliation or management of the terminal illness as well as related conditions;

(b) the beneficiary must elect hospice care in accordance with ARM 37.40.815;

(c) a plan of care must be established as set forth in ARM 37.40.805 and 37.40.807 before services are provided. The services must be consistent with the plan of care; and

(d) a certification that the beneficiary is terminally ill must be completed as set forth in ARM 37.40.808.

(2) For covered hospice services, Medicaid will generally pay for the services covered by Medicare. Medicare coverage of hospice services is described under 42 CFR 418.200 through 418.205.

(a) Physician services is a covered hospice service and must be performed by a doctor of medicine or osteopathy.

(b) Outpatient drugs and biologicals not related to the terminal conditions will be reimbursed separately under the provisions of ARM 37.86.1101, 37.86.1102, and 37.86.1105.


History: 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 1989 MAR p. 842, Eff. 7/1/89; AMD, 1990 MAR p. 539, Eff. 3/16/90; TRANS, from SRS, 2000 MAR p. 489; AMD, 2016 MAR p. 1167, Eff. 7/9/16; AMD, 2022 MAR p. 1672, Eff. 8/6/22.

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