Section 1130.3. Definitions

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

Attending physician—A physician who is:

(i) A doctor of medicine or osteopathy.

(ii) Identified by the recipient, at the time he elects to receive hospice care, as having the most significant role, in the determination and delivery of medical care to the recipient.

Bereavement counseling—Guidance and spiritual support provided to the recipient’s family after the recipient’s death.

Certification period—A period of 60 consecutive days, at the beginning of which a certification of terminal illness has been filed under § 1130.22 (relating to duration of coverage).

Core services—Nursing care, medical social services, physician services and counseling services as specified in Medicare regulations at 42 CFR 418.82—418.88 (relating to core services).

Employe of the hospice—An individual performing a substantial and regular service for the hospice either for remuneration by the hospice provider or on a voluntary basis. The term includes an individual who provides some services on a voluntary basis and receives payment for other services and an individual who is appropriately trained and assigned to the hospice unit if the hospice is a subdivision of an agency or organization.

Freestanding hospice—A hospice that is not part of another type of participating provider.

Hospice—A public agency or private organization or subdivision of either of these that is primarily engaged in providing care to terminally ill individuals.

Hospice services—Services that are reasonable and necessary for the palliation or management of the recipient’s terminal illness and related conditions.

Representative—A person who, because of the recipient’s mental or physical incapacity, is authorized in accordance with State law to execute or revoke an election for hospice care or terminate curative medical care on behalf of the terminally ill recipient.

Terminally ill—A recipient who has a medical prognosis that his life expectancy is 6 months or less.

Unrelated condition—A health problem that could not reasonably be expected to be caused by the terminal illness. The term includes a dental abscess in a recipient with terminal cancer of the colon and a nonpathologic fracture or other injury sustained by a recipient with lung cancer; a pre-existing condition such as diabetes would also be considered unrelated to a terminal diagnosis such as leukemia.

Notation

Cross References

This section cited in 55 Pa. Code § 1130.41 (relating to election of hospice care); and 55 Pa. Code § 1130.51 (relating to provider enrollment requirements).