10 Colo. Code Regs. § 2505-10-8.7536

Current through Register Vol. 47, No. 24, December 25, 2024

Section 10 CCR 2505-10-8.7536 - Palliative/Supportive Care

8.7536.APalliative/Supportive Care Eligibility

1. Palliative/Supportive Care is a covered benefit available to Members enrolled in the HCBS Children with Life Limiting Illness Waiver.

8.7536.BPalliative/Supportive Care Definition

1. Palliative/Supportive Care means a specific program of specialized medical care for Members with life limiting illness offered by a licensed healthcare facility or provider that is specifically focused on the provision of organized palliative care services. Palliative care shall be focused on providing Members with relief from the symptoms, pain, and stress of serious illness, whatever the diagnosis. The goal shall be to improve the quality of life for both the Member and the family. Palliative care may be provided to Members of any age and at any stage in a life limiting illness. Palliative care services shall be provided by a Hospice or Home Care Agency staff who have received additional training in palliative care concepts such as adjustment to illness, advance care planning, symptom management, and grief/loss. For the purpose of the CLLI waiver, Palliative Care shall include Care Coordination and Pain and Symptom Management.

8.7536.C Palliative/Supportive Care Inclusions

1. Palliative/Supportive Care may be provided together with curative treatment and includes:

a. Care Coordination

i. Care Coordination includes development and implementation of a care plan, home visits for regular monitoring of the health and safety of the Member and central coordination of medical and psychological services.

ii. A Care Coordinator will organize an array of services. This approach will enable the Member to receive all medically necessary care in the community with the goal of avoiding institutionalization in an acute care hospital.

iii. Additionally, a key function of the Care Coordinator shall be to manage the majority of the responsibility, otherwise placed on the Parents, for condensing, organizing, and making accessible to providers critical information that is related to the care and necessary for effective medical management.

iv. Care Coordination does not include Case Management Agency or Case Manager responsibilities.

b. Pain and Symptom Management

i. Pain and Symptom Management means nursing care in the home by a registered nurse to manage the Member's symptoms and pain. Management includes regular, ongoing pain and symptom Assessments to determine efficacy of the current regimen and available options for optimal relief of symptoms.

ii. Management also includes as needed visits to provide relief of suffering, during which, nurses assess the efficacy of current pain management and modify the regimen if needed to alleviate distressing symptoms and side effects using pharmacological, non-pharmacological and complementary/supportive therapies.

8.7536.DPalliative/Supportive Care Provider Agency Requirements

1. Individuals providing Palliative/Supportive Care services shall be employed by or working under a formal contract with a qualified Medicaid hospice or Home Health Agency.

2. The services shall be provided by Hospice or Home Care Agency staff who have received additional training in palliative care concepts such as adjustment to illness, advance care planning, symptom management, and grief/loss.

10 CCR 2505-10-8.7536

47 CR 03, February 10, 2024, effective 3/16/2024

47 CR 21, November 10, 2024, effective 11/30/2024