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.
Covered Hospice services are available to recipients in their Home, Nursing Facility or ICF/IID 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 younger than 21 eligible for Hospice benefits are eligible to receive curative treatment in relation to their terminal illness concurrently with Hospice services.
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.
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.
Hospice benefits shall consist of two 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:
9200 Shelbyville Road Suite 800
Louisville, KY 40222
Fax: 800-292-2392, Option 9
Notice: Effective for dates of service Jan. 1, 2016 and later, Hospice providers will be able to bill for service intensity add-on payments for routine home care services provided by a registered nurse or medical social worker during the last seven days of a patient's life. Billing for the service intensity add-on payment should be on a separate line and/or claim from your routine home care payment billing using revenue codes 551 or 561, as appropriate. Procedure code G0299 will be required with the use of revenue code 551 and G0155 will be required with the use of revenue code 561. Service intensity add-on payments must be billed in 15-minute increments (one unit is equal to 15 minutes) and billed on a claim with occurrence code 55 and an associated occurrence date that reflects the member's date of death. Revenue codes 551 and 561 must be billed as a single date of service per line (span-dating is not allowed). Please continue billing for your regular routine home care payments with revenue code 651 using the current billing guidelines and unit increment.
Regarding billing: contact HP at 800-807-1232 or visit the website.
Regarding members: contact 800-635-2570.
Provider Services: contact (855) 824-5615.
Regarding prior authorization: contact SHPS at 800-292-2392.
Regarding Provider Enrollment: contact Provider Enrollment at 877-838-5085 or visit the website.