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Hospice Services

Medicaid covers hospice services for terminally ill recipients. Hospice care provides palliative care, relief of pain and other symptoms, for persons in the last phase of an incurable disease so that they can live as fully and comfortably as possible. Hospice also provides supportive services to terminally ill persons and assistance to their families in adjusting to the patient's illness and death.

For more information on Hospice, refer below to view:

Eligibility Information

Medicaid Hospice services are available to recipients with a terminal diagnosis that have been certified by a physician to have a life expectancy of six months or less.

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General Information

Covered Hospice services are available to recipients in their Home, Nursing Facility or ICF/MR setting. Hospice services are reasonable and necessary for the palliation or management of the terminal illness as well as related conditions as detailed in the Hospice regulations and Hospice Services Manual.

In order to receive Hospice services, the recipient must elect Hospice coverage using the MAP-374 - Election of Medicaid Hospice Benefit Form.

Recipients that elect Hospice will receive treatment for conditions related to their terminal illness by their Hospice provider.

Recipients under the age of twenty-one (21) eligible for Hospice benefits are eligible to receive curative treatment in relation to their terminal illness concurrently with Hospice services.

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Medicare Information

If an individual is eligible for Medicare as well as Medicaid (dual eligibility), the hospice benefit must be elected and revoked simultaneously under both programs.

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Benefit Information

Hospice benefits shall consist of two (2) ninety (90) day periods.

Additional 60 day extension of Hospice benefits periods are covered until revocation or termination for other reasons such as ineligibility or death. Recertification is required for each 60 day extension benefit period.

Send the MAP-374, MAP-375, MAP-376, MAP-378 and MAP-403 to the local DCBS Office for processing.

Mail or fax the MAP-383, MAP-384, MAP-397 and MAP-377 to:
Carewise Health
9200 Shelbyville Road Suite 800
Louisville, KY 40222
Fax: (800)292-2392, Option 9

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Regulations, Policy Information, Letters, Forms and Billing Instructions


Policy Information

Provider Letters

Hospice Provider Letter #A-200 - 2014 Hospice Rates (October 20, 2014)

To view the letters, refer to the Provider Letter page.


  • MAP-374 - Election of Medicaid Hospice Benefit Form (Rev. 12/11)
  • MAP-375 - Revocation of Medicaid Hospice Benefits
  • MAP-376 - Change of Hospice Providers
  • MAP-377 - Recertification for Extension of Medicaid Hospice Benefits
  • MAP-378 - Termination of Medicaid Hospice Benefits
  • MAP-379 - Representation Statement for Election of Hospice Benefits
  • MAP-383 - Other Hospital Statement Form
  • MAP-397 - Other Services Statement Form
  • MAP-403 -Hospice Patient Status Change

Billing Information

Provider Billing Instructions


If you have questions?

Regarding Policy, contact
Division of Community Alternatives
Home and Community Based Services Branch
275 East Main Street
6 W-B
Frankfort, KY 40621
Phone: (502) 564-5560
Email: CHFS DMS Webmaster

Regarding billing, contact EDS at (800) 807-1232 or visit their website

Regarding members, contact Member Services at (800) 635-2570

Regarding prior authorization, contact (800) 292-2392

Regarding Provider Enrollment , contact Provider Enrollment at (877) 838-5085 or visit their website.


Last Updated 11/13/2014