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Hospice Plan of Care
Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch.9 §40)
For hospice care to be covered, in addition to the election of services and the written certification of terminal illness, a plan of care (POC) must be established before services are provided. The POC is like a roadmap for the beneficiary’s care, containing problems, interventions, and goals. The POC must be established the same day the assessment is done, if that assessment day is to be a covered day of hospice care. Date the POC on the day it is first established.
The member of the basic Interdisciplinary Team (IDT) who assesses the beneficiary must consult with one other member of the IDT to establish the initial POC, either in person or by telephone. At least one member of the IDT establishing the initial POC must be either a nurse or a physician.
The POC must be reviewed and updated at intervals specified in the POC. It should continually be assessed to ensure that the care the beneficiary receives meets their conditions and needs. The POC should be updated if the beneficiary's condition improves or deteriorates and when the level of care changes. The POC will include an assessment of the individual's needs and identification of the services, including the management of discomfort and symptom relief. It must state in detail the scope and frequency of services needed to meet the beneficiary's and family's needs. A thorough POC acts as a road map for the IDT to provide consistent, cohesive care, and will support the medical necessity of hospice care.
Page last updated: May 17, 2010
