<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.35.06" title_num="10" subtitle_num="09" chapter_num="35" heading="Covered Services.">
  <paragraph num="A.">
    <text>Hospice care includes the services listed in §B of this regulation when the services are:</text>
    <paragraph num="(1)">
      <text>Provided to an eligible recipient who elects hospice care, in accordance with Regulation .05 of this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Reasonable and necessary for the palliation or management of the participant's terminal illness and related conditions;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Consistent with the plan of care established before the services are provided;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Provided by appropriately qualified personnel;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Administered according to accepted standards of practice; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Routinely provided directly by provider employees, when they are the core services listed in §B(1)—(4) of this regulation, except that the provider may contract for supplemental services during peak patient loads, under extraordinary circumstances, or to obtain physician specialty services.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The following are covered hospice care services:</text>
    <paragraph num="(1)">
      <text>Nursing care provided by a nurse licensed as a registered nurse in the jurisdiction in which services are provided or by an individual under the supervision of a registered nurse;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Medical social services provided by a social worker who is:</text>
      <paragraph num="(a)">
        <text>In compliance with the social work licensing requirements of the jurisdiction in which service is provided; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Working under the direction of a physician;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Physician services performed by a physician as described in 42 CFR §§410.20—410.25, except that the services of the provider's medical director or physician member of the interdisciplinary group shall be performed by a doctor of medicine or osteopathy;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Counseling services provided to the participant and the family members or other persons caring for the participant at home, including:</text>
      <paragraph num="(a)">
        <text>Dietary counseling;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Counseling to train the participant's family or other caregivers in providing care;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Spiritual counseling to help the participant and the family or other caregivers in the home to adjust to the participant's approaching death;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Bereavement counseling for the family after the participant's death; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Additional counseling provided by interdisciplinary group members, as well as by other qualified professionals as necessary;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Short-term inpatient care subject to the following conditions:</text>
      <paragraph num="(a)">
        <text>General inpatient care may be provided to meet the participant's needs for pain control or for acute or chronic symptom management that cannot be met in other settings;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Inpatient respite care may be furnished to provide rest or relief for family members or other individuals routinely furnishing at-home care to the participant; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>General inpatient care and inpatient respite care shall be provided in a:</text>
        <paragraph num="(i)">
          <text>Hospice that meets the conditions of participation for providing inpatient care directly as set forth in 42 CFR §418.100; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Hospital, skilled nursing facility, or nursing facility that meets the special hospice standards regarding 24-hour nursing service and patient areas as set forth in 42 CFR §418.100(a) and (e);</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Medical appliances and supplies, including drugs and biologicals, which are needed for the palliation and management of the terminal illness and related conditions;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Home health aide and homemaker services furnished by qualified individuals, who are under the general supervision of a registered nurse; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Physical therapy, occupational therapy, and speech-language pathology services provided by qualified individuals for purposes of symptom control or to enable the participant to maintain activities of daily living and basic functional skills.</text>
    </paragraph>
  </paragraph>
</regulation>