(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 individual 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 individual 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.

(a) Physicians' 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.

(3) The department adopts and incorporates by reference the following section of 42 CFR as amended August 4, 2011:

(a) 418.202 except for those provisions which apply to physicians services.

(4) The department adopts and incorporates by reference the following sections of 42 CFR as amended August 6, 2009:

(a) 418.200; and

(b) 418.204.

(5) The department adopts and incorporates by reference the following section of 42 CFR as amended November 5, 2004:

(a) 418.205.

(6) The incorporated material sets forth requirements for Medicare coverage of hospice services. A copy of the sections of CFR listed in (3), (4), and (5) may be obtained from the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59320-2951.