{"component": "clause", "props": {"groups": [{"size": 55, "snippet_links": [{"key": "a-member", "type": "definition", "offset": [27, 35]}, {"key": "attending-physician", "type": "clause", "offset": [42, 61]}, {"key": "the-member", "type": "clause", "offset": [77, 87]}, {"key": "life-span", "type": "definition", "offset": [125, 134]}, {"key": "six-months-or-less", "type": "clause", "offset": [138, 156]}], "snippet": "Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.", "samples": [{"hash": "jASYWaMJ7Ip", "uri": "/contracts/jASYWaMJ7Ip#hospice-services", "label": "Medical and Hospital Service Contract", "score": 26.8439426422, "published": true}, {"hash": "hmkX4Xx5Bbh", "uri": "/contracts/hmkX4Xx5Bbh#hospice-services", "label": "Medical and Hospital Service Contract", "score": 26.8439426422, "published": true}, {"hash": "gig0mUAXAqn", "uri": "/contracts/gig0mUAXAqn#hospice-services", "label": "Medical and Hospital Service Contract", "score": 26.8439426422, "published": true}], "hash": "c04c11074459b15f6fa27e8c9c647338", "id": 1}, {"size": 34, "snippet_links": [{"key": "services-provided", "type": "definition", "offset": [11, 28]}, {"key": "hospice-care", "type": "clause", "offset": [154, 166]}, {"key": "medical-services", "type": "definition", "offset": [176, 192]}, {"key": "pain-management", "type": "clause", "offset": [201, 216]}, {"key": "emotional-support", "type": "definition", "offset": [229, 246]}, {"key": "for-example", "type": "clause", "offset": [248, 259]}], "snippet": "Supportive services provided to patients who have reached the terminal stage of their illness when aggressive, curative therapy is no longer appropriate. Hospice care includes medical services such as pain management, as well as emotional support (for example, counseling) for both patients and their families.", "samples": [{"hash": "2nEVsnylCdG", "uri": "/contracts/2nEVsnylCdG#hospice-services", "label": "Contract for Medicaid Managed Care Services", "score": 36.1728286743, "published": true}, {"hash": "g6zo7s74ogX", "uri": "/contracts/g6zo7s74ogX#hospice-services", "label": "Medicaid Managed Care Services Agreement", "score": 36.1701431274, "published": true}, {"hash": "5Xjm26bNTKv", "uri": "/contracts/5Xjm26bNTKv#hospice-services", "label": "Contract for Medicaid Managed Care Services", "score": 36.1701431274, "published": true}], "hash": "3b6c894b829dcac2be679de6ad763c5b", "id": 2}, {"size": 25, "snippet_links": [{"key": "mco-must", "type": "clause", "offset": [7, 15]}, {"key": "care-and-use", "type": "clause", "offset": [32, 44]}, {"key": "in-accordance-with", "type": "definition", "offset": [73, 91]}, {"key": "the-provisions", "type": "clause", "offset": [92, 106]}, {"key": "hospice-program", "type": "clause", "offset": [191, 206]}, {"key": "previously-enrolled", "type": "clause", "offset": [220, 239]}, {"key": "a-ph", "type": "clause", "offset": [320, 324]}, {"key": "for-the-department", "type": "definition", "offset": [359, 377]}, {"key": "the-member", "type": "clause", "offset": [432, 442]}, {"key": "responsibility-of-the", "type": "clause", "offset": [459, 480]}], "snippet": "The PH-MCO must provide hospice care and use certified hospice Providers in accordance with the provisions outlined at 42 C.F.R. 418.1 et seq. Recipients who are enrolled in the Department\u2019s Hospice Program and were not previously enrolled in the HealthChoices Program will not be enrolled in HealthChoices. However, if a PH-MCO Member is determined eligible for the Department\u2019s Hospice Program after being enrolled in the PH-MCO, the Member will remain the responsibility of the PH-MCO and will not be disenrolled from HealthChoices.", "samples": [{"hash": "i6oCf5gLq77", "uri": "/contracts/i6oCf5gLq77#hospice-services", "label": "Healthchoices Physical Health Grant Agreement", "score": 31.9040088654, "published": true}, {"hash": "lzRETkycNtq", "uri": "/contracts/lzRETkycNtq#hospice-services", "label": "Grant Agreement", "score": 31.4964447021, "published": true}, {"hash": "8iqd1qXcSga", "uri": "/contracts/8iqd1qXcSga#hospice-services", "label": "Grant Agreement", "score": 30.9366436005, "published": true}], "hash": "fc9915808686a105648161437aa15e5a", "id": 3}, {"size": 11, "snippet_links": [{"key": "in-accordance-with", "type": "definition", "offset": [0, 18]}, {"key": "the-act", "type": "clause", "offset": [68, 75]}, {"key": "payments-to-the", "type": "clause", "offset": [130, 145]}, {"key": "hospice-provider", "type": "definition", "offset": [146, 162]}, {"key": "nursing-facility", "type": "definition", "offset": [178, 194]}, {"key": "the-member", "type": "clause", "offset": [198, 208]}, {"key": "facility-rate", "type": "definition", "offset": [355, 368]}], "snippet": "In accordance with 1905(o)(3)(C), 1902(a)(13)(B) and 1902(a)(32) of the Act, and 42 CFR 447.10, the MCOP shall pay room and board payments to the hospice provider instead of the nursing facility if the member resides in a nursing facility and is receiving hospice services. Room and board payments to hospice providers must be at least 95% of the nursing facility rate.", "samples": [{"hash": "hRalBEAa49o", "uri": "/contracts/hRalBEAa49o#hospice-services", "label": "Provider Agreement", "score": 36.4264315835, "published": true}, {"hash": "4Bn9PoRFaHi", "uri": "/contracts/4Bn9PoRFaHi#hospice-services", "label": "Provider Agreement", "score": 35.6923561096, "published": true}, {"hash": "2xLJIel4Fdd", "uri": "/contracts/2xLJIel4Fdd#hospice-services", "label": "Provider Agreement", "score": 35.4378166199, "published": true}], "hash": "1361dabb05e295f45fdaba11ac09017f", "id": 4}, {"size": 10, "snippet_links": [{"key": "palliative-care", "type": "definition", "offset": [22, 37]}, {"key": "terminally-ill", "type": "definition", "offset": [41, 55]}, {"key": "the-member", "type": "clause", "offset": [222, 232]}, {"key": "assisted-living-facility", "type": "definition", "offset": [298, 322]}, {"key": "nursing-home", "type": "definition", "offset": [324, 336]}, {"key": "hospice-provider", "type": "definition", "offset": [396, 412]}, {"key": "a-member", "type": "definition", "offset": [483, 491]}, {"key": "responsible-for", "type": "clause", "offset": [514, 529]}, {"key": "services-provided-by", "type": "clause", "offset": [572, 592]}, {"key": "a-registered-nurse", "type": "clause", "offset": [593, 611]}, {"key": "licensed-practical-nurse", "type": "definition", "offset": [615, 639]}, {"key": "durable-medical-equipment", "type": "clause", "offset": [711, 736]}, {"key": "prescribed-drugs", "type": "definition", "offset": [740, 756]}, {"key": "related-to", "type": "definition", "offset": [757, 767]}, {"key": "occupational-therapy", "type": "clause", "offset": [880, 900]}, {"key": "speech-therapy", "type": "definition", "offset": [902, 916]}, {"key": "social-service", "type": "definition", "offset": [929, 943]}, {"key": "home-health-aide-services", "type": "clause", "offset": [983, 1008]}, {"key": "family-counseling-services", "type": "clause", "offset": [1012, 1038]}, {"key": "continuous-home-care", "type": "definition", "offset": [1042, 1062]}, {"key": "period-of", "type": "clause", "offset": [1086, 1095]}, {"key": "continuous-care", "type": "definition", "offset": [1131, 1146]}, {"key": "nursing-care", "type": "definition", "offset": [1166, 1178]}, {"key": "management-of", "type": "clause", "offset": [1204, 1217]}, {"key": "inpatient-services", "type": "definition", "offset": [1248, 1266]}, {"key": "other-settings", "type": "clause", "offset": [1441, 1455]}, {"key": "not-eligible", "type": "definition", "offset": [1471, 1483]}, {"key": "to-receive", "type": "definition", "offset": [1484, 1494]}, {"key": "hospice-care-benefits", "type": "clause", "offset": [1503, 1524]}, {"key": "authorized-representative", "type": "definition", "offset": [1555, 1580]}, {"key": "measures-to", "type": "clause", "offset": [1637, 1648]}, {"key": "benefits-for-covered", "type": "clause", "offset": [1663, 1683]}, {"key": "services-are-provided", "type": "clause", "offset": [1692, 1713]}, {"key": "date-of", "type": "clause", "offset": [1732, 1739]}, {"key": "your-death", "type": "clause", "offset": [1740, 1750]}], "snippet": "Hospice care involves palliative care to terminally ill Members and their families with such services being centrally coordinated through a multi-disciplinary team directed by a Physician. Most hospice care is provided in the Member\u2019s home or facility that the Member has designated as home. (i.e. Assisted Living Facility, Nursing Home, etc.) All eligible hospice services must be billed by the hospice provider. Benefits for hospice care include the following services provided to a Member by a hospice provider responsible for the Member's overall care: \uf0b7 Professional services provided by a registered nurse or licensed practical nurse; \uf0b7 Palliative care by a Physician; \uf0b7 Medical and surgical supplies and durable medical equipment; \uf0b7 Prescribed drugs related to the hospice diagnosis (drugs and biologicals); \uf0b7 Oxygen and its administration; \uf0b7 Therapies (physical medicine, occupational therapy, speech therapy); \uf0b7 Medical social service consultations; \uf0b7 Dietitian services; \uf0b7 Home health aide services; \uf0b7 Family counseling services; \uf0b7 Continuous Home Care provided only during a period of crisis in which a patient requires continuous care which is primarily nursing care to achieve palliation or management of acute medical symptoms; and \uf0b7 Inpatient services of an acute medical nature arranged through the hospice provider in a hospital or skilled setting to address short-term pain and/or symptom control that cannot be managed in other settings. The member is not eligible to receive further hospice care benefits if the member or the member's authorized representative elects to institute curative treatment or extraordinary measures to sustain life. Benefits for Covered Hospice Services are provided until the earlier date of your death or discharge from Hospice Care.", "samples": [{"hash": "1yHf4fONIv9", "uri": "/contracts/1yHf4fONIv9#hospice-services", "label": "Individual Hmo Subscriber Agreement", "score": 23.8843250275, "published": true}, {"hash": "k8cBChs7uVY", "uri": "/contracts/k8cBChs7uVY#hospice-services", "label": "Individual Hmo Subscriber Agreement", "score": 23.8829574585, "published": true}, {"hash": "cfporzFXbOZ", "uri": "/contracts/cfporzFXbOZ#hospice-services", "label": "Hmo Subscriber Agreement", "score": 23.8829574585, "published": true}], "hash": "6b359fa678984850c78174574816df32", "id": 5}, {"size": 10, "snippet_links": [{"key": "necessary-for", "type": "definition", "offset": [9, 22]}, {"key": "management-of", "type": "clause", "offset": [42, 55]}, {"key": "terminal-illness", "type": "definition", "offset": [56, 72]}, {"key": "related-conditions", "type": "definition", "offset": [77, 95]}, {"key": "these-services-include", "type": "clause", "offset": [97, 119]}, {"key": "supportive-care", "type": "definition", "offset": [120, 135]}, {"key": "the-family", "type": "clause", "offset": [148, 158]}, {"key": "other-individuals", "type": "clause", "offset": [163, 180]}, {"key": "caring-for", "type": "definition", "offset": [181, 191]}, {"key": "terminally-ill", "type": "definition", "offset": [196, 210]}], "snippet": "Services necessary for the palliation and management of terminal illness and related conditions. These services include supportive care provided to the family and other individuals caring for the terminally ill recipient. Wis. Admin Code DHS 107.31", "samples": [{"hash": "hC0OtLeJYyc", "uri": "/contracts/hC0OtLeJYyc#hospice-services", "label": "Contract for Services", "score": 25.0999317169, "published": true}, {"hash": "6v04hdzEGL4", "uri": "/contracts/6v04hdzEGL4#hospice-services", "label": "Contract for Services", "score": 24.4770698547, "published": true}, {"hash": "6KHda9QcaiX", "uri": "/contracts/6KHda9QcaiX#hospice-services", "label": "Contract for Services", "score": 24.4414787292, "published": true}], "hash": "5374afd228a9c55cb560b7e87f3beaa2", "id": 6}, {"size": 9, "snippet_links": [{"key": "mco-must", "type": "clause", "offset": [8, 16]}, {"key": "in-accordance-with", "type": "definition", "offset": [69, 87]}, {"key": "eligible-participants", "type": "definition", "offset": [169, 190]}, {"key": "medicare-coverage", "type": "clause", "offset": [231, 248]}], "snippet": "The CHC-MCO must provide Hospice and use certified Hospice Providers in accordance with 42 C.F.R. Subpart G. The CHC-MCO must coordinate with Hospice Providers for Dual Eligible Participants who are receiving Hospice through their Medicare coverage. Hospice provided to Participants by Medicare-approved Hospice Providers is directly reimbursed by Medicare.", "samples": [{"hash": "4noAAfqIJPJ", "uri": "/contracts/4noAAfqIJPJ#hospice-services", "label": "Community Healthchoices Agreement", "score": 22.2245044708, "published": true}, {"hash": "lxY7J635kRJ", "uri": "/contracts/lxY7J635kRJ#hospice-services", "label": "Community Healthchoices Agreement", "score": 21.7741279602, "published": true}, {"hash": "lziRLDzuRX6", "uri": "/contracts/lziRLDzuRX6#hospice-services", "label": "Community Healthchoices Agreement", "score": 20.8843250275, "published": true}], "hash": "1eb4402593a38cfcbc225e469779f1e4", "id": 7}, {"size": 8, "snippet_links": [{"key": "members-receiving-hospice-services", "type": "clause", "offset": [90, 124]}, {"key": "examples-of", "type": "definition", "offset": [212, 223]}, {"key": "hospice-care", "type": "clause", "offset": [238, 250]}, {"key": "not-limited", "type": "clause", "offset": [268, 279]}, {"key": "skilled-nursing-facilities", "type": "clause", "offset": [311, 337]}, {"key": "hospital-admissions", "type": "clause", "offset": [342, 361]}, {"key": "information-on", "type": "clause", "offset": [375, 389]}, {"key": "policy-manual", "type": "definition", "offset": [444, 457]}, {"key": "prior-authorization", "type": "definition", "offset": [486, 505]}, {"key": "managed-care", "type": "definition", "offset": [514, 526]}, {"key": "policies-and-procedures-manual", "type": "definition", "offset": [536, 566]}], "snippet": "Hospice services are covered under the Hoosier Care Connect Program. Hoosier Care Connect members receiving hospice services will remain enrolled with their MCE even while receiving inpatient (non-hospice) care. Examples of inpatient non-hospice care includes but are not limited to: rehabilitation facilities, skilled nursing facilities and hospital admissions. For further information on Hospice services consult the Indiana Medicaid Medical Policy Manual, the Hospice Module and the Prior Authorization Module, Managed Care Programs Policies and Procedures Manual.", "samples": [{"hash": "bbXfE9tTyS3", "uri": "/contracts/bbXfE9tTyS3#hospice-services", "label": "Contract", "score": 29.1556339264, "published": true}, {"hash": "3P81Y9K56f2", "uri": "/contracts/3P81Y9K56f2#hospice-services", "label": "Contract", "score": 29.1556339264, "published": true}, {"hash": "4fBh2AprOBi", "uri": "/contracts/4fBh2AprOBi#hospice-services", "label": "Contract #0000000000000000000018227", "score": 28.7888259888, "published": true}], "hash": "1e8ca04fb7fa2aa66cd212d1aed784e5", "id": 8}, {"size": 7, "snippet_links": [{"key": "fifty-percent", "type": "definition", "offset": [0, 13]}, {"key": "average-wholesale-price", "type": "clause", "offset": [27, 50]}, {"key": "related-to", "type": "definition", "offset": [57, 67]}, {"key": "injectable-medications", "type": "clause", "offset": [120, 142]}], "snippet": "Fifty percent (50%) of the average wholesale price (AWP) related to chemotherapy drugs (intravenously administered) and injectable medications administered during a visit to the physician\u2019s office (excluding take-home insulin).", "samples": [{"hash": "b8DCPpfc8dT", "uri": "/contracts/b8DCPpfc8dT#hospice-services", "label": "Medical Services Agreement (Prospect Medical Holdings Inc)", "score": 21.0, "published": true}, {"hash": "5fFtIyYMNL1", "uri": "/contracts/5fFtIyYMNL1#hospice-services", "label": "Medical Services Agreement (Prospect Medical Holdings Inc)", "score": 21.0, "published": true}, {"hash": "ag4FIYyAJSU", "uri": "/contracts/ag4FIYyAJSU#hospice-services", "label": "Medical Services Agreement (Prospect Medical Holdings Inc)", "score": 19.0, "published": true}], "hash": "5192223215c3fba2a15e4f60945bf02f", "id": 9}, {"size": 4, "snippet_links": [{"key": "hospice-care", "type": "clause", "offset": [0, 12]}, {"key": "in-the-home", "type": "definition", "offset": [29, 40]}, {"key": "hospice-facility", "type": "definition", "offset": [49, 65]}, {"key": "psychological-services", "type": "clause", "offset": [92, 114]}, {"key": "terminal-illness", "type": "definition", "offset": [155, 171]}, {"key": "services-include", "type": "clause", "offset": [181, 197]}, {"key": "routine-home-care", "type": "definition", "offset": [198, 215]}, {"key": "continuous-home-care", "type": "definition", "offset": [217, 237]}, {"key": "to-be-eligible-for", "type": "clause", "offset": [280, 298]}, {"key": "hospice-benefits", "type": "clause", "offset": [299, 315]}, {"key": "life-expectancy", "type": "definition", "offset": [341, 356]}, {"key": "six-months-or-less", "type": "clause", "offset": [360, 378]}, {"key": "certified-by", "type": "definition", "offset": [383, 395]}, {"key": "attending-physician", "type": "clause", "offset": [400, 419]}, {"key": "hospice-medical-director", "type": "definition", "offset": [424, 448]}, {"key": "covered-health-services", "type": "clause", "offset": [450, 473]}, {"key": "terminally-ill", "type": "definition", "offset": [621, 635]}], "snippet": "Hospice care may be provided in the home or at a Hospice facility where medical, social and psychological services are given to help treat patients with a terminal illness. Hospice Services include routine home care, continuous home care, Inpatient Hospice and Inpatient respite. To be eligible for Hospice benefits, the patient must have a life expectancy of six months or less, as certified by the attending Physician and hospice medical director. Covered Health Services will continue if the Enrollee lives longer than six months, provided the hospice medical director or other hospice doctor recertifies that You are terminally ill.", "samples": [{"hash": "hMhLZFPV2va", "uri": "/contracts/hMhLZFPV2va#hospice-services", "label": "Health Insurance Contract", "score": 24.3579730988, "published": true}, {"hash": "6F4BR4cPwfR", "uri": "/contracts/6F4BR4cPwfR#hospice-services", "label": "Health Maintenance Organization Contract", "score": 24.3579730988, "published": true}, {"hash": "dRlm7BK6kCm", "uri": "/contracts/dRlm7BK6kCm#hospice-services", "label": "Health Insurance Contract", "score": 23.8542098999, "published": true}], "hash": "16cb03de227a24acc71d1a0522691b81", "id": 10}], "next_curs": "ClkSU2oVc35sYXdpbnNpZGVyY29udHJhY3RzcjULEhZDbGF1c2VTbmlwcGV0R3JvdXBfdjU2Ihlob3NwaWNlLXNlcnZpY2VzIzAwMDAwMDBhDKIBAmVuGAAgAA==", "clause": {"parents": [["covered-medical-services", "COVERED MEDICAL SERVICES"], ["covered-services", "Covered Services"], ["clarifications", "Clarifications"], ["program-requirements", "PROGRAM REQUIREMENTS"], ["general", "GENERAL"]], "children": [["", ""], ["general-member-information-requirements", "General Member Information Requirements"], ["member-id-card", "Member ID Card"], ["member-information-education-and-outreach", "Member Information, Education and Outreach"], ["marketing-and-outreach", "Marketing and Outreach"]], "size": 229, "title": "Hospice Services", "id": "hospice-services", "related": [["ambulance-services", "Ambulance Services", "Ambulance Services"], ["voice-services", "Voice Services", "Voice Services"], ["education-services", "Education services", "Education services"], ["surgery-services", "Surgery Services", "Surgery Services"], ["pharmacy-services", "Pharmacy Services", "Pharmacy Services"]], "related_snippets": [], "updated": "2025-07-23T06:00:56+00:00", "also_ask": [], "drafting_tip": null, "explanation": "The Hospice Services clause defines the scope and provision of care for patients who are terminally ill, focusing on comfort and quality of life rather than curative treatment. It typically outlines the types of services provided, such as pain management, emotional support, and assistance with daily activities, and may specify eligibility criteria or the process for initiating hospice care. This clause ensures that patients and their families understand the available support and the shift in care objectives, addressing the need for compassionate, coordinated end-of-life care."}, "json": true, "cursor": ""}}