(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. The department hereby adopts and incorporates by reference 42 CFR 418.202 through 418.204, as amended through October 1, 1988, except for those provisions of 42 CFR 418.202 which apply to physicians' services. The incorporated material sets forth requirements for medicare coverage of hospice services. Copies of 42 CFR 418.202 through 418.204, as amended through October 1, 1988, except for those provisions of 42 CFR 418.202 which apply to physicians' services, are available from the Department of Public Health and Human Services, Health Policy and Services Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(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, 37.86.1105 and 46.12.701.