Ga. Medicaid Part II Policies & Procedures for Hospice Services § 803

Children are not required to forego curative care when electing hospice and may concurrently

receive palliative and curative treatment. Hospice services are available to children eligible for

Medicaid and Medicaid-expansion CHIP programs without forgoing any other treatment to which

the child is entitled under Medicaid. Hospice palliative services and supports to children continue to

include pain and symptom management, and family counseling provided by specialty- trained

hospice staff. Effective August 1, 2019 for Children from ages 0 to 21 (20 years + 11 months), the

DMA-521A form for non-related Hospice diagnosis /non-palliative care services are no longer

required to be submitted with the claim. This modification is for all non-hospice providers rendering

services for care not related to the terminal illness. (Rev. 10/2019)

803.1. GAPP: In-Home Skilled Nursing Care and Waiver Services

An individual currently enrolled in the GAPP Program’s In-Home Nursing Care

Program that has been diagnosed with a terminal illness may elect to enroll in the

Hospice program. The GAPP member may receive some services that are determined

not to be duplicative of hospice services.

803.2. Concurrent Care

Effective 3/23/10, children are not required to forego curative care when electing

hospice. Hospice Services and supports to children continue to include pain, symptom

management and family counseling provided by specialty trained hospice staff.

Duplication of concurrent curative care and hospice services is not permitted. If a

member has elected hospice and is in another Medicaid program, it is incumbent upon

the Hospice provider to coordinate the multiple plans of care and eliminate the

duplication of Medicaid services. Once conducted, both the hospice and other Medicaid

provider must document coordination activities and retain such documentation and

resulting coordinated plans of care in the member’s medical record.

Hospice skilled nursing is intermittent in nature for symptom and crisis management

while the GAPP nursing is provided in shifts for routine nursing care relating to all

member’s skilled nursing needs based on medical necessity.

It would be anticipated that the hospice nurse and the GAPP nurse would sometimes be

in the home at the same time which would allow for assuring that the coordinated plan

of care continues to be current and applicable to the member and family needs.

The hospice provider will initiate contact with the GAPP nursing agency to develop a

coordinated Plan of Care. This coordinated Plan of Care will be kept in the member’s

home as well as sending a copy to the AHS Medical Review Team with the member’s

PA request for GAPP services.

Upon choosing hospice services, the member will maintain a hospice lock-in with the

hospice as the primary for care coordination with the hospice nurse providing in home

services at least once per week to assure continued coordination of care with GAPP

services.