Ga. Medicaid Part II Policies & Procedures for Hospice Services § 603

If an individual, other than SSI recipients with an Aged, Blind & Disabled designation (ABD)

choosing to receive hospice services has a pending Medicaid status or undetermined eligibility, the

hospice forms should not be sent to Gainwell Technologies by the agency until the individual is

determined by Division of Family and Children Services (DFCS) to be Medicaid eligible and has

been assigned their Medicaid number. For reimbursement, it is the responsibility of the hospice

agency to frequently monitor and verify the individual’s Medicaid eligibility. This applies to all

applicants except individuals with Social Security Income (SSI with ABD); those members are

previously determined by the Social Security office to be eligible for Medicaid. SSI members that

are nursing facility applicants or residents may be subject to an expanded review by DFCS after

admission.

If an individual (other than SSI recipients whose eligibility for full ABD Medicaid has already been

established) choosing to receive hospice services has a pending Medicaid status or undetermined

eligibility, the hospice forms should not be sent to Gainwell Technologies by the agency until the

individual is determined by Division of Family and Children Services (DFCS) to be Medicaid

eligible and has been assigned their Medicaid number. Those such as SSI/ABD recipients with

Medicaid only, may receive a lock-in upon review through a direct submission to Gainwell

Technologies. Providers are to submit applications to DFCS prior to sending them over to Gainwell

Technologies for lock-ins but, may submit the applications to both DFCS and Gainwell

Technologies simultaneously. Gainwell Technologies will then send a Member Enrollment

Acknowledgement Letter to the provider as notification of the receipt of documents.

Once DFCS has assigned the individual’s Medicaid number, the agency must submit the initial

Medicaid Hospice Election Form (DMA-579) and a copy of one of the following as

proof of Medicaid eligibility:

603.1. Web Portal print screen. The Election Form and Web Portal Screen print are sent 30

days from the effective date of eligibility under the Retro Eligibility Spans.

603.2. Notification of Benefits Letter (NOBL) sent to member from the DFCS. The Election

Form and Notification of Benefits Letter are sent 30 days from the posted date on the

NOBL.

603.3. Hospice Care Communicator (HCC) returned to the Hospice Agency from DFCS. The

Election Form and HCC are sent 30 days from the date of the DFCS Caseworker

signature.

To be considered timely, the proof of eligibility must be submitted with the Medicaid Election Form.

If the election form is received without one of the three (3) documents, the member will be locked in

per the date the election form is received by DCH. The effective date of the hospice election date

cannot be prior to the date of Medicaid eligibility. If the aid category is updated after 30 days,

Gainwell Technologies shall give the provider the initial lock-in date upon confirmation that the

DMA-579 was sent timely. A lock-in will not be applied without an updated aid category, unless the

member is a SSI recipient.

If a member expires before achieving a Hospice eligibility update, it is no longer a DFCS/eligibility

matter and must be submitted to Gainwell Technologies. Members cannot obtain eligibility updates

once a DOD is updated in a members file. However, a lock-in can still be granted through Gainwell

Technologies from the first date of service through the DOD (given that all necessary documentation

submitted complete, legibly signed, and within 30 days of the member electing to receive Hospice

services). Gainwell Technologies will review them and lock them in accordingly. Providers are to

submit lock-In requests for expired members as they would a normal lock-In request to Gainwell

Technologies. Providers are welcome to add a note on their documentation stating, “Member has

expired and cannot receive a Hospice eligibility update. Please consider for DOD lock-in from the

first date of service through date of death.”

Application(s) can be submitted via fax (including all necessary documentation) or through Gateway.

If aid categories are not being updated timely, an “Application” and/or a “Request to Change” can be

sent through Gateway. If the Nursing Facility has submitted an “Application” or a “Request to

Change” and attached the Hospice Care Communicator (HCC), 59 and 579, Nursing Facilities

should have a tracking number (T) from Gateway and Hospice providers can obtain this number.

(Rev. 07/2018)

If completing the application, and the tracking number is received, the Hospice agency shall fax the

forms to DFCS and/or submit an email to the appropriate ABD (Aged, Blind, and Disabled)

Customer Service Contact with the tracking number.

*NOTE: A DFCS contact list can be found on GAMMIS under Provider Notices.

The faxed confirmation page from your agency’s fax machine will be requested, if necessary, to

verify these documents were sent timely. Please be sure your agency’s fax machine displays the date,

time and telephone number where faxed. Please include the member’s name on the cover sheet

associated with the election form.