Medical Social Services

40.1.2 - Medical Social Services (Rev. 141, Issued: 03-02-11, Effective: 01-01-11: Implementation: 03-23-11) Medical social services must be provided by a person who meets the criteria given in the Conditions of Participation at 42 CFR 418.114(b)(3). Services of these professionals which may be covered include, but are not limited to: 1. Assessment of the social and emotional factors related to the patient’s illness, need for care, response to treatment and adjustment to care; 2. Assessment of the relationship of the patient’s medical and nursing requirements to the patient’s home situation, financial resources and availability of community resources; 3. Appropriate action to obtain available community resources to assist in resolving the patient’s problem (NOTE: Medicare does not cover the services of a medical social worker to complete or assist in the completion of an application for Medicaid because Federal regulations require the State to provide assistance in completing the application to anyone who chooses to apply for Medicaid.); 4. Counseling services that are required by the patient; and 5. Medical social services furnished to the patient’s family member or caregiver on a short-term basis when the hospice can demonstrate that a brief intervention (that is, two or three visits) by a medical social worker is necessary to remove a clear and direct impediment to the effective palliation and management of the patient’s terminal illness and related conditions. To be considered “clear and direct,” the behavior or actions of the family member or caregiver must plainly obstruct, contravene, or prevent the patient’s medical treatment. Medical social services to address general problems that do not clearly and directly impede treatment, as well as long-term social services furnished to family members, such as ongoing alcohol counseling, are not covered.