Medi-Cal Provider Manual, Part 2, Hospice Care, Primary Care Physician Services

‹‹Hospice providers are required to provide all necessary services related to the terminal

illness within the four levels of care – except for primary care physician services, that may be

provided and billed directly by the attending physician, and special physician services

related to the terminal illness, that may be billed separately by the hospice provider.››

Services Covered

‹‹Special physician services are those furnished by a physician hospice employee or a

physician under arrangement with the hospice for managing symptoms that cannot be

remedied by Medi-Cal members’ attending physician because of (1) immediate need or (2)

the attending physician does not have the required special skills. (For example, a urologist

assists the Medi-Cal member in voiding when the bladder is pathologically obstructed).››

Services Not Covered

When Medi-Cal members are under the care of hospice providers, separate payment will not

be made, or treatment authorizations approved, for the following when they are directly

related to the terminal diagnosis:

• Hospital

• Nursing Facility Level A or B

• Home Health Agency care

• Medical supplies and appliances

• Drugs and biologicals

• Durable Medical Equipment (DME)

• Medical transportation

• Any other services, as specified in California Code of Regulations (CCR), Title 22,

related to Medi-Cal members’ terminal diagnosis

Note: ‹‹Medi-Cal members under the age of 21 who are receiving hospice services are also

eligible to receive concurrent curative treatment related to the terminal illness

pursuant to the federal EPSDT benefit, and as specified in the ACA Section 2302.››

Copayments

In accordance with federal requirements, no Medi-Cal copayments may be collected from

Medi-Cal members who are receiving hospice services for any Medi-Cal services, including

services that are not related to the terminal illness.