Basic Considerations
To be eligible under the Hospice Care class of assistance an A/R must meet the following conditions:
The A/R has a medical prognosis of six months or less life expectancy.
The A/R is receiving hospice care services from an approved hospice care provider.
The A/R meets the Length of Stay (LOS) and Level of Care (LOC) basic eligibility criteria.
The A/R meets all other basic and financial eligibility criteria
Hospice care services are provided to the A/R by a Medicaid hospice agency. The A/R may reside at home or in a nursing home.
Hospice care services include but are not limited to the following:
nursing home
medical social services
physician services
counseling services
respite care
home health aide services
DMA only reimburses for medical services provided by the hospice care agency. These recipients receive a Medicaid card that identifies them as hospice care recipients, with a notation to medical service providers that all claims must be submitted through the hospice agency. If the A/R has prescription needs which are not covered through the Hospice provider and are not related to the Hospice diagnosis, the authorizing physician must submit to DCH a statement containing the Hospice diagnosis, what the unrelated drug is and why it is necessary. This statement should be sent for approval to: DCH Pharmacy Services Unit 2 Martin Luther King Jr. Drive SE East Tower, 19 th Floor Atlanta, Georgia 30303
All SSI recipients receiving Institutionalized Hospice must be entered and processed in Gateway. These cases should be consistent with case management for SSI only nursing home cases. See 2578 SSI Recipients .
There is no patient liability or cost share for A/Rs in a home setting. However, for Hospice A/Rs in a NH setting, a PL/CS is determined the same as for NH A/Rs. See 2136 Institutionalized Hospice .