Authority: IC 12-8-6.5-5; IC 12-15

Affected: IC 12-15

Sec. 7. (a) When an eligible member elects to receive services from a certified hospice provider, the provider shall develop a plan of care. For the Medicaid-only hospice members, the provider must submit the Medicaid plan of care form to the office or the office's contractor with the Medicaid physician certification and the Medicaid election statement. For members less than twenty-one (21) years of age concurrently receiving hospice and curative care services, the providers rendering those services must submit an updated coordinated plan of care, including delineation of hospice and curative care services, to the office or the office's contractor.

(b) In developing the plan of care, the provider must comply with the following procedures:

1. (1) The interdisciplinary team member who drafts the plan must confer with at least one (1) other member of the interdisciplinary team.
2. (2) One (1) of the conferees must be a physician or nurse, and all other team members must review the plan of care.
3. (3) All services stipulated within the plan of care must be reasonable and necessary for the palliation or management of the terminal illness and related conditions.
4. (4) For the Medicaid-only hospice member, the Medicaid hospice plan of care must be included in the member's medical chart at the hospice agency. If the Medicaid-only member resides in a nursing facility, the Medicaid plan of care must also be included in the member's nursing facility medical chart.
5. (5) For the dually-eligible Medicare/Medicaid hospice member residing in a nursing facility, a coordinated plan of care prepared and agreed upon by the hospice and nursing facility must be included in the member's nursing facility medical chart.

6. (6) For members less than twenty-one (21) years of age concurrently receiving hospice and curative care services, the Medicaid plan of care must include the information identified previously in this section, and a coordinated plan of care must be prepared and agreed upon by the hospice interdisciplinary team and the provider or providers rendering the curative care services. The plan of care must include the following:

   1. (A) An assessment of the member's needs.
   2. (B) The curative care and hospice services the member is receiving along with the scope and frequency of these services and the manner in which the services and assessments are coordinated.
7. The plan of care must be included in the member's medical charts of both the hospice and curative care providers. The advanced directive, if applicable, must be included in the member's medical charts of both the hospice and curative care providers.

(Office of the Secretary of Family and Social Services; 405 IAC 5-34-7; filed Mar 9, 1998, 9:30 a.m.: 21 IR 2382; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; filed Jun 5, 2003, 8:30 a.m.: 26 IR 3640; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; filed Feb 14, 2013, 9:48 a.m.: 20130313-IR-405120451FRA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA; filed Aug 1, 2016, 3:44 p.m.: 20160831-IR-405150418FRA; readopted filed Jul 28, 2022, 2:21 p.m.: 20220824-IR-405220205RFA; readopted filed May 30, 2023, 11:54 a.m.: 20230628-IR-405230292RFA)