Common use of COVERAGE/BENEFITS Clause in Contracts

COVERAGE/BENEFITS. (a) The hospice program agrees to provide the care and services set forth in 32 CFR 199.4(e)(19)(i). (b) The hospice program further agrees to provide for such care and services in individuals’ homes, on an outpatient basis, and on a short-term inpatient basis, directly or under arrangements made by the hospice program, except that the agency must: (1) Routinely supply a substantial amount of core-services (i.e., nursing services; physician services; medical social services; and counseling) services for the TRICARE beneficiary and his or her family (32 CFR 199.4(e)(19)(ii)). (2) Maintain professional management responsibility of non-core services (i.e., home health aide services, medical appliances and supplies, physical therapy, occupational therapy, speech-language pathology and short-term inpatient care) which are not directly furnished to the patient, regardless of the location or facility in which the services are rendered (32 CFR 199.4(e)(19)(iii)). (3) Make nursing services, physician services, and drugs and biologicals routinely available on a 24-hour basis. All other covered services must be available on a 24-hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for palliation and management of the terminal illness and related condition (32 CFR 199.4(e)(19)(iv)). (4) Provide assurances that the aggregate number of days of inpatient care provided in any 12-month period does not exceed 20% of the aggregate number of days of hospice care during the same period. (5) Have an interdisciplinary group (i.e., one physician; one registered nurse; one social worker; and one pastoral or other counselor) who provides those services set forth in 32 CFR 199.4(e)(19)(i) and establishes the policies governing the provision of such services/care. (6) Maintain central clinical records on all patients.

COVERAGE/BENEFITS. (a) The hospice program agrees to provide the care and services set forth in 32 CFR 199.4(e)(19)(i). (b) The hospice program further agrees to provide for such care and services in individuals’ homes, on an outpatient basis, and on a short-term inpatient basis, directly or under arrangements made by the hospice program, except that the agency must: (1) Routinely supply a substantial amount of core-services (i.e., nursing services; physician services; medical social services; and counseling) services for the TRICARE TRICARE/CHAMPUS beneficiary and his or her family (32 CFR 199.4(e)(19)(ii)). (2) Maintain professional management responsibility of non-core services (i.e., home health aide services, medical appliances and supplies, physical therapy, occupational therapy, speech-language pathology and short-term inpatient care) which are not directly furnished to the patient, regardless of the location or facility in which the services are rendered (32 CFR 199.4(e)(19)(iii)). (3) Make nursing services, physician services, and drugs and biologicals routinely available on a 24-hour basis. All other covered services must be available on a 24-24- hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for palliation and management of the terminal illness and related condition (32 CFR 199.4(e)(19)(iv)). (4) Provide assurances that the aggregate number of days of inpatient care provided in any 12-month period does not exceed 20% 20 percent of the aggregate number of days of hospice care during the same period. (5) Have an interdisciplinary group (i.e., one physician; one registered nurse; one social worker; and one pastoral or other counselor) who provides those services set forth in 32 CFR 199.4(e)(19)(i) and establishes the policies governing the provision of such services/care. (6) Maintain central clinical records on all patients.

COVERAGE/BENEFITS. (a) The hospice program agrees to provide the care and services set forth in 32 CFR 199.4(e)(19)(i). (b) The hospice program further agrees to provide for such care and services in individuals’ ' homes, on an outpatient basis, and on a short-term inpatient basis, directly or under arrangements made by the hospice program, except that the agency must: (1) Routinely supply a substantial amount of core-services (i.e., nursing services; physician services; medical social services; and counseling) services for the TRICARE TRICARE/CHAMPUS beneficiary and his or her family (32 CFR 199.4(e)(19)(ii)). (2) Maintain professional management responsibility of non-core services (i.e., home health aide services, medical appliances and supplies, physical therapy, occupational therapy, speech-language pathology and short-term inpatient care) which are not directly furnished to the patient, regardless of the location or facility in which the services are rendered (32 CFR 199.4(e)(19)(iii)). (3) Make nursing services, physician services, and drugs and biologicals routinely available on a 24-hour basis. All other covered services must be available on a 24-24- hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for palliation and management of the terminal illness and related condition (32 CFR 199.4(e)(19)(iv)). (4) Provide assurances that the aggregate number of days of inpatient care provided in any 12-month period does not exceed 20% 20 percent of the aggregate number of days of hospice care during the same period. (5) Have an interdisciplinary group (i.e., one physician; one registered nurse; one social worker; and one pastoral or other counselor) who provides those services set forth in 32 CFR 199.4(e)(19)(i) and establishes the policies governing the provision of such services/care. (6) Maintain central clinical records on all patients.

COVERAGE/BENEFITS. (a) The hospice program agrees to provide the care and services set forth in 32 CFR 199.4(e)(19)(i199.4(e) (19)(i). (b) The hospice program further agrees to provide for such care and services in individuals’ homes, on an outpatient basis, and on a short-term inpatient basis, directly or under arrangements made by the hospice program, except that the agency must: (1) Routinely supply a substantial amount of core-services (i.e.e.g., nursing services; physician services; medical social services; and counseling) services for the TRICARE beneficiary and his or her family (32 CFR 199.4(e)(19)(ii199.4(e) (19) (ii)). (2) Maintain professional management responsibility of non-core services (i.e.e.g., home health aide services, medical appliances and supplies, physical therapy, occupational therapy, speech-speech- language pathology and short-term inpatient care) which are not directly furnished to the patient, regardless of the location or facility in which the services are rendered (32 CFR 199.4(e)(19)(iii199.4(e) (19) (iii)). (3) . Make nursing services, physician services, and drugs and biologicals routinely available on a 24-24- hour basis. All other covered services must be available on a 24-hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for palliation and management of the terminal illness and related condition (32 CFR 199.4(e)(19)(iv199.4(e) (19) (iv)). (43) Provide assurances that the aggregate number of days of inpatient care provided in any 12-12- month period does not exceed 20% of the aggregate number of days of hospice care during the same period. (54) Have an interdisciplinary group (i.e., one physician; one registered nurse; one social worker; and one pastoral or other counselor) who provides those services set forth in 32 CFR 199.4(e)(19)(i199.4(e) (19)(i) and establishes the policies governing the provision of such services/care. (65) Maintain central clinical records on all patients.

COVERAGE/BENEFITS. ‌ (a) The hospice program agrees to provide the care and services set forth in 32 CFR 199.4(e)(19)(i). (b) The hospice program further agrees to provide for such care and services in individuals’ ' homes, on an outpatient basis, and on a short-term inpatient basis, directly or under arrangements made by the hospice program, except that the agency must: (1) Routinely supply a substantial amount of core-services (i.e., nursing services; physician services; medical social services; and counseling) services for the TRICARE /CHAMPUS beneficiary and his or her family (family. ( 32 CFR 199.4(e)(19)(ii)). (2) Maintain professional management responsibility of non-core services (i.e., home health aide services, medical appliances and supplies, physical therapy, occupational therapy, speech-language pathology and short-term inpatient care) which are not directly furnished to the patient, regardless of the location or facility in which the services are rendered (rendered. ( 32 CFR 199.4(e)(19)(iii)). (3) Make nursing services, physician services, and drugs and biologicals routinely available on a 24-hour basis. All other covered services must be available on a 24-24- hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for palliation and management of the terminal illness and related condition condition. (32 CFR 199.4(e)(19)(iv)). (4) Provide assurances that the aggregate number of days of inpatient care provided in any 12-month period does not exceed 20% 20 percent of the aggregate number of days of hospice care during the same period. (5) Have an interdisciplinary group (i.e., one physician; one registered nurse; one social worker; and one pastoral or other counselor) who provides those services set forth in 32 CFR 199.4(e)(19)(i) and establishes the policies governing the provision of such services/services / care. (6) Maintain central clinical records on all patients.patients.‌

COVERAGE/BENEFITS. (a) The hospice program agrees to provide the care and services set forth in 32 CFR 199.4(e)(19)(i). (b) The hospice program further agrees to provide for such care and services in individuals’ ' homes, on an outpatient basis, and on a short-term inpatient basis, directly or under arrangements made by the hospice program, except that the agency must: (1) Routinely supply a substantial amount of core-services (i.e., nursing services; physician services; medical social services; and counseling) services for the TRICARE TRICARE/CHAMPUS beneficiary and his or her family family. (32 CFR 199.4(e)(19)(ii)). (2) Maintain professional management responsibility of non-core services (i.e., home health aide services, medical appliances and supplies, physical therapy, occupational therapy, speech-language pathology and short-term inpatient care) which are not directly furnished to the patient, regardless of the location or facility in which the services are rendered rendered. (32 CFR 199.4(e)(19)(iii)). (3) Make nursing services, physician services, and drugs and biologicals routinely available on a 24-hour basis. All other covered services must be available on a 24-24- hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for palliation and management of the terminal illness and related condition condition. (32 CFR 199.4(e)(19)(iv)). (4) Provide assurances that the aggregate number of days of inpatient care provided in any 12-month period does not exceed 20% 20 percent of the aggregate number of days of hospice care during the same period. (5) Have an interdisciplinary group (i.e., one physician; one registered nurse; one social worker; and one pastoral or other counselor) who provides those services set forth in 32 CFR 199.4(e)(19)(i) and establishes the policies governing the provision of such services/care. (6) Maintain central clinical records on all patients.

COVERAGE/BENEFITS. ‌ (a) The hospice program agrees to provide the care and services set forth in 32 CFR 199.4(e)(19)(i). (b) The hospice program further agrees to provide for such care and services in individuals’ ' homes, on an outpatient basis, and on a short-term inpatient basis, directly or under arrangements made by the hospice program, except that the agency must: (1) Routinely supply a substantial amount of core-services (i.e., nursing services; physician services; medical social services; and counseling) services for the TRICARE / CHAMPUS beneficiary and his or her family family. (32 CFR 199.4(e)(19)(ii)). (2) Maintain professional management responsibility of non-core services (i.e., home health aide services, medical appliances and supplies, physical therapy, occupational therapy, speech-language pathology and short-term inpatient care) which are not directly furnished to the patient, regardless of the location or facility in which the services are rendered rendered. (32 CFR 199.4(e)(19)(iii)). (3) Make nursing services, physician services, and drugs and biologicals routinely available on a 24-hour basis. All other covered services must be available on a 24-24- hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for palliation and management of the terminal illness and related condition condition. (32 CFR 199.4(e)(19)(iv)). (4) Provide assurances that the aggregate number of days of inpatient care provided in any 12-month period does not exceed 20% 20 percent of the aggregate number of days of hospice care during the same period. (5) Have an interdisciplinary group (i.e., one physician; one registered nurse; one social worker; and one pastoral or other counselor) who provides those services set forth in 32 CFR 199.4(e)(19)(i) and establishes the policies governing the provision of such services/services / care. (6) Maintain central clinical records on all patients.patients.‌