Ga. Medicaid Part II Policies & Procedures for Hospice Services § 902

In establishing the initial plan of care, the member of the basic interdisciplinary group who assesses

the patient’s needs must meet or call at least one other group member (nurse, physician, medical

social worker or counselor) before writing the initial plan of care. At least one of the persons

involved in developing the initial plan must be a nurse or physician. This plan must be established on

the same day as the assessment if the day of assessment is to be a covered day of hospice care. The

plan of care must be dated on the day it is first established. The other two members of the basic

interdisciplinary group, the attending physician, and the medical director or physician designee must

review the initial plan of care and provide their input to the process of establishing the plan of care

within two (2) calendar days following the day of assessment.

The hospice provider must ascertain if a Medicaid member who has elected hospice is enrolled or

participates in another Medicaid program to coordinate the multiple plans of care, therefore, avoiding

overlapping services and to eliminate the duplication of Medicaid services. A coordinated POC must

also reference curative care for pediatric patients scheduled to receive such medical care concurrent

to hospice care. The hospice provider must document coordination activities and retain such

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

coordinated POC must be submitted with the election and/or recertification forms to Gainwell

Technologies within a 30-day period prior to lock-in for the Medicaid provider lock-in or member

certified span extension by Gainwell Technologies.

Failure of the Hospice provider to coordinate care of the member enrolled in other Medicaid

programs will be considered a failure to comply with the terms of hospice policy. Coordination of

care must be evidenced in the member’s hospice POC and primary record. Documentation reflecting

the coordination of care must accompany the submission of the election form in the request for lock-in. Lack of evidence of coordinated care in documentation submitted for election, lock-in, etc., will

result in hospice forms that are not processed for the hospice member lock-in and are returned to the

provider by the fiscal agent, Gainwell Technologies. All claims are subject to recoupment when

failure to coordinate care is not evidenced.

Failure to comply with any of the above policy means that the hospice patient would not be eligible

for the Medicaid Hospice Benefit. Forms and other information submitted will not be processed for

the hospice member lock-in and /or extension and will be returned to the provider by Gainwell

Technologies as applicable. The hospice may continue to serve the patient under hospice care, but in

doing so assumes all financial responsibility and Medicaid will not reimburse the hospice provider

for that care. The patient becomes a Medicaid hospice member only when all Medicaid eligibility

criteria are met.