Policies & Guidelines
- Compliance
- Definitions
- Ambulatory Surgical Services
- Billing Policy
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Legal References
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- Ambulatory Surgical Services
- Billing Policy
- CFSS
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- Equipment and Supplies
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Member Eligibility
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Quality: HEDIS
- Policies & Procedures
Hospice Services
Definitions
Cap Amount: The yearly limit on overall hospice payment.
Crisis: A period during which the member requires continuous care for palliation or management of acute medical symptoms.
Continuous Home Care Day: A day in which the member receives nursing services including home health or homemaker services on a continuous basis during a period of crisis for at least eight hours and as many as 24 hours per day, as necessary to maintain the member at home.
More than half the care during the crisis must be nursing care provided by a registered nurse (RN) or licensed practical nurse (LPN). The hospice uses the hourly rate for the actual hours of services provided, up to 24 hours.
Core Based Statistical Area (CBSA) Rate: Location code to determine hospice rate by state and county.
Employee: An employee of the hospice or, if the hospice is a subdivision of an agency or organization, an employee of the agency or organization assigned to the hospice unit, including a volunteer under the supervision of the hospice.
General Inpatient Day: A day in which the member receives general inpatient care in a hospital, Skilled Nursing Facility (SNF), or inpatient hospice unit for control of pain or management of acute or chronic symptoms that cannot be managed in the home.
Home: The member’s place of residence.
Hospice Care: The services provided by a hospice to a terminally ill member.
Inpatient Care: The hospice services provided by an inpatient facility to a member who has been admitted to a hospital, long-term care facility (LTCF), or facility of a hospice that provides care 24 hours per day.
Inpatient Facility: A hospital, LTCF, or facility of a hospice that provides care 24 hours per day.
Interdisciplinary Group: A group of qualified individuals with expertise in meeting the special needs of hospice recipients and their families, including, at a minimum, providers of core services. An interdisciplinary group must have at least one physician, one registered professional nurse, one social worker, and one pastoral or other counselor.
Legal Representative: A person who, under Minnesota law, may execute or revoke an election of hospice care on behalf of the member because the terminally ill member is mentally or physically incapacitated.
Palliative Care: Care affording relief, but not cure, providing an alleviating medicine. Palliative care includes managing the symptoms experienced by the hospice recipient. The intent is to enhance the quality of life for the hospice recipient and their family, but not directed at curing the disease.
Respite Care: Short-term inpatient care provided to the member only when necessary to relieve the family members or other people caring for the member.
Social Worker: A person who has at least a bachelor’s degree in social work from a program accredited or approved by the Council on Social Work Education and who complies with the Minnesota Statutes related to social work licensure.
Terminally Ill: A medical prognosis with a life expectancy of six months or less, given that the terminal illness runs its normal course.
PW_03-19_134
Updated_12/11/2025
