Utah Admin. Code R414-14A-2 - Definitions
In addition to the definitions in Rule R414-1, the following definitions apply to this rule.
(1)
"Adult" means a member who is 21 years of age or older.
(2) "Attending physician" means:
(a) an individual identified by the member
when the member elects to receive hospice care as having the most significant
role in determining and delivering the member's medical care; and
(b) a healthcare practitioner who is:
(i) a physician who is a doctor of medicine
or osteopathy; or
(ii) a nurse
practitioner or physician assistant who meets proper training, education, and
experience requirements within their scope of licensing.
(3) "Cap period" means the
12-month period ending September 30 used in the application of the cap on
overall hospice reimbursement specified in
42 CFR
418.309.
(4) "Consecutive months" means any number of
months in a row wherein a hospice agency provides hospice care under the
Medicaid benefit, including any portion of a month.
(5) "Continuous home care day" means a day in
which a member, who has elected to receive hospice care at home, receives a
minimum of eight aggregate hours of care from the hospice provider during a
24-hour day, which begins and ends at midnight. The eight aggregate hours of
care must be predominantly nursing care provided by either a registered nurse
or licensed practical nurse.
(6)
"General inpatient care day" means a day when a member with elected hospice
care receives general inpatient care for pain control or acute or chronic
symptom management that is not manageable in the member's place of residence or
another outpatient setting.
(7)
"Hospice agency" means an agency licensed under Rule R432-750 and is primarily
engaged in providing hospice care to terminally ill individuals.
(8) "Inpatient respite care day" means a day
when a member with elected hospice care receives short-term inpatient care
necessary to relieve family members or other persons caring for the member at
their place of residence.
(9)
"Palliative care" means patient and family-centered care that optimizes quality
of life by anticipating, preventing, and treating suffering. Palliative care
addresses physical, intellectual, emotional, social, and spiritual needs while
facilitating patient autonomy, access to information, and choice.
(10) "Pediatric" means a member who is under
21 years of age.
(11) "Pediatric
hospice agency" means an enrolled hospice agency that has trained employees in
providing hospice care to patients who are younger than 21 years of
age.
(12) "Representative" means an
individual who is authorized under state law to make health care decisions on
behalf of a member, including initiating, continuing, refusing, or terminating
medical treatments for a member who cannot make these decisions.
(13) "Terminally ill" means a medical
prognosis to live no more than six months if the illness runs its ordinary
course.
Notes
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