We offer 10 counseling sessions to clients (community or hospice-related). Now, if someone needs more than 10 sessions, we have an internal "reauthorization" process that involves the counselor completing a review form and submitting it for approval. Clients who are "reauthorized" are given 10 additional session, and then we repeat this reauthorization process every 10 sessions. So, in short, clients can continue as long as there is a grief-related need and we remain the best source of service to meet that need, and there is evidence that we are making progress. However, we only publically talk about the 10 sessions and don't advertise the reauthorization process because we want to help keep clients focused and keep the clinical relationship from evolving into a friendly visitng or companioning-style relationship.
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As for the compliance piece Sarah mentioned, there are no specific Medicare requirements that counseling visits be offered or available through the hospice (although many hospices make this available to some degree. Others may utilize a referral system to community resources for counseling and only provide telephone and mailing support). Medicare COPs dictate needing to have an established bereavement program, but there are very little specifics about what that program must look like.
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Daniel
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