Ga. Medicaid Part II Policies & Procedures for Hospice Services § 710

Hospice agencies and the county Department of Family and Children Services (DFCS) offices

should provide information to each other regarding individuals whose eligibility is being determined

under the Hospice Medicaid coverage group. The HCC and the HCC Status Change located in

Appendix C should be used for this exchange of information. These forms should not be submitted to

the Division of Medical Assistance; however, a copy of everyone’s form is sent to Gainwell

Technologies Enterprise Services, the fiscal agent for the member’s hospice elections and

certifications for extended hospice span requests.

The HCC is to be used to communicate the individual’s Hospice Medicaid eligibility status and

patient liability amounts. The hospice agency will complete top portion, Section I with signature,

and fax to the county DFCS office in the Region where the individual resides. (See Appendix C).

When the review of eligibility is completed, providers can access section II for the eligibility status,

patient liability amount (if one is assessed), the effective date and Medicaid identification number

that is needed for claim purposes.

An eligibility review by the county DFCS office should be completed within forty-five (45) to sixty

(60) calendar days from the date of application; however, eligibility can be made retroactive to the

month of application, including up to three (3) months prior.

The HCC Status Change form should be completed, signed and forwarded to the county DFCS office

whenever changes occur in any of the five (5) situations specified on the form. The HCC Status

Change form should be used to verify an individual’s election status on hospice care services when a

certification period expires, including revocation and discharge of hospice care services. This form

must be forwarded to the county DFCS office no later than the last day of each certification period so

that Medicaid eligibility under the hospice care coverage group continues without interruption for

those individuals electing continued services. The forms may be photocopied for use as needed.

If there is a problem with patient liability, the hospice agency should contact the local Department of

Family and Children Services (DFCS) to resolve the issue.