Ga. Medicaid Part II Policies & Procedures for Hospice Services § 905

When a resident of a Medicare/Medicaid Nursing Facility (NF) elects the Medicare/ Medicaid

hospice benefit or Medicaid only hospice benefit, the hospice agency and the NF must communicate,

establish, and agree upon a coordinated Plan of Care for both providers which reflects the hospice

philosophy, and is based on an assessment of the individual’s needs and unique living situation in the

NF. The hospice agency assumes full responsibility for professional management of the individual’s

hospice care and makes any arrangements necessary for inpatient care. Even though the NF is the

hospice individual’s residence for purposes of the hospice benefit, the NF must still comply with all

NF requirements for participation in Medicare or Medicaid.

905.1. The coordinated Plan of Care must reflect, at a minimum, the following:

905.1.1. Identification of the care and services which the SNF/NF and hospice

agency will provide to be responsive to the needs of the individual;

905.1.2. Establishment of the time frame for the revision and update of the Plan

of Care as necessary to reflect the individual’s status;

905.1.3. Identification of the individual’s current, physical, psychosocial and

spiritual needs.

905.1.4. The hospice agency must designate an RN from the hospice agency to

coordinate the implementation of the Plan of Care.

905.2. All covered hospice services must be available as necessary to meet the needs of the

individual.

905.3. All core services must be routinely provided directly by hospice agency employees and

cannot be delegated to the SNF/NF (See Section 904). The hospice agency may involve

the SNF/NF nursing personnel in assisting with the administration of prescribed

therapies included in the Plan of Care only to the extent that the hospice agency would

routinely utilize the services of a hospice individual’s family/caregiver in implementing

the Plan of Care.

905.4. Drugs and medical supplies must be provided as needed for the palliation and

management of the terminal illness and related conditions. Drugs must be furnished in

accordance with accepted professional standards of practice.

905.5. The hospice agency may arrange to have non-core hospice services provided by the

SNF/NF if the hospice agency assumes professional management responsibility for

these services and assures that these services are performed in accordance with the

policies of the hospice agency and the individual’s Plan of Care.

905.6. The hospice agency receives the room and board payment in addition to the appropriate

level of care rate from the Division. The hospice agency is responsible for reimbursing

the nursing facility for the room and board according to the contract between the

hospice and the nursing facility.

NOTE:

The Division will only reimburse the hospice for room and board for those days the

individual is in the nursing facility.

The Division does not pay room and board on the day of discharge or death when a

hospice member is living in a nursing facility.

The Division does not pay to reserve a bed when a hospice individual living in a

nursing facility goes into the hospital or goes to visit family members.

The hospice reimbursement of the nursing facility for room and board is d dependent on

the contract between the hospice provider and the n nursing facility when the individual

is outside the nursing home.

905.7. Room and board services include:

905.7.1. Performing personal care services.

905.7.2. Assisting with activities of daily living.

905.7.3. Administering medications.

905.7.4. Socializing activities.

905.7.5. Maintaining the cleanliness of an individual’s room; and

905.7.6. Supervision and assisting in the use of Durable Medical Equipment

(DME) and prescribed therapies.

Refer to Chapter 1000, Section 1009 - regarding reimbursement of nursing facility

room and board.