Ga. Medicaid Part II Policies & Procedures for Hospice Services § 711

For purposes of the Medicaid hospice benefit, the nursing facility is considered the residence of the

Medicaid and/or Medicare enrolled individual. An individual who meets the eligibility criteria for

hospice services residing in such a setting may elect the hospice benefit according to the procedures

outlined in Chapter 700. The hospice agency must have a written + with the nursing facility in which

the individual resides and the nursing facility must concur with the hospice Plan of Care (See

Chapter 900). The individual must be formally discharged from the nursing facility (NF). A DMA-

59 must be completed by the NF and submitted to the Department of Family and Children Services

(DFCS). The hospice agency must submit a copy of this DMA-59 to Gainwell Technologies with the

member’s election form and a copy of the HCC form for the hospice election provider lock- in. A

hospice agency may furnish routine or continuous (limited) home care to the Medicaid only enrolled

individual who resides in a nursing facility. Individuals residing in the nursing facility who elect the

hospice benefit are ineligible to receive respite care services from Medicare or Medicaid.

General Inpatient Care and Nursing Home Room and Board cannot be reimbursed for the same

individual for the same covered days of service (See Section 902). Nursing Home Room and Board

cannot be reimbursed for an individual on the day of discharge or death.