Ga. Medicaid Part II Policies & Procedures for Hospice Services § 1007

The Division will pay the hospice in accordance with the usual Medicaid reimbursement for

physician services (such as direct patient care services) when these services are provided by hospice

employees or physicians under agreement with the hospice. This reimbursement is in addition to the

per diem rate. Reimbursement for physician services is included in the amount subject to the hospice

payment cap described in Section 1007. Services furnished voluntarily by physicians are not

reimbursable.

Consultant specialty services, when necessary for the palliative care and management of the terminal

illness (e.g., radiation for pain relief), are covered separately and are reimbursed only to the elected

hospice. Services of the patient’s attending physician, if he or she is not an employee of the hospice

or providing services under arrangements with the hospice, are not considered covered hospice

services and are not included in the amount subject to the hospice cap. These services are paid

directly to the provider physician. Reimbursement is provided for enrolled nurse practitioner

services, except for certifying the terminal illness with a prognosis of 6 months or less, to

Medicaid member who have elected the hospice benefit and have selected a nurse practitioner as the

attending physician. The hospice must notify the Division of the name of the physician who has been

designated as the attending physician by the member.