Ga. Medicaid Part II Policies & Procedures for Hospice Services § 907

An individual currently enrolled in a Medicaid waiver program that is diagnosed with a terminal

illness may elect to enroll in the Hospice program. The member may continue to receive some

waiver services that are determined by Medicaid as not duplicative of the hospice services. Because

the member who is a waiver services recipient may only enroll in hospice secondary to the waiver

enrollment (i.e., a member who has elected hospice cannot enroll in a waiver enroll), it is the

responsibility of the hospice provider to ascertain if the member is enrolled or participates in another

Medicaid program. Once other programs are identified, 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 waiver providers must document coordination activities and retain

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

Applicable waiver programs are:

907.1. New Options Waiver (NOW)

907.2. Comprehensive Supports Waiver (COMP)

907.3. Independent Care Waiver Program (ICWP)

907.4. Community Care Services Program (CCSP)

907.5. Georgia Pediatric Program (concurrent)

907.6. Service Options Using Resources in Community Environment (SOURCE)

The policy and procedure manual for each of the waiver programs listed above has a specified list of

services that an individual can continue to receive if they elect the hospice program. Hospice

agencies are encouraged to review these policies prior to enrolling an individual that is enrolled in a

waiver program.

Providers may use the website at www.mmis.georgia.gov to obtain a copy of the applicable waiver

program policy and procedure manual.

907.7. The hospice agency continues to assume full responsibility for the professional

management of the individual’s hospice care in accordance with the hospice Conditions

of Participation. When an individual enrolled in a waiver program elect’s hospice:

907.7.1. The hospice agency, the member’s waiver case manager and member

must communicate, establish, and agree upon a coordinated plan of care

for both providers that reflects the hospice philosophy and is based on an

assessment of the individual’s need and unique living situation.

The Hospice provider must coordinate care of the member enrolled in

other Medicaid programs, i.e., Home and Community-Based Waivers

and Nursing Facilities, as evidenced in the member’s hospice plan of

care (POC). Failure to demonstrate that multiple Medicaid plans of care

have been coordinated will be considered a failure to comply with the

terms of hospice policy. As such, lack of evidence of coordinated care in

documentation will result in a terminated lock-in and any paid claims for

hospice services will be subject to recoupment.

907.7.2. For pediatric patients scheduled to receive concurrent curative care, a

coordinated POC must also reference dates of medical care to be

administered to the member by supporting Hospitals and Outpatient

Clinic services.

907.7.3. All hospice services must continue to be provided directly by hospice

employees. The services cannot be delegated. When the member is in a

waiver program residential facility, the hospice agency may involve the

facility staff in assisting the administration of prescribed therapies that

are included in the plan of care; this is only to the extent that the hospice

would routinely utilize the service of the patient’s family/caregiver in

implementing the plan of care.

907.7.4. When the member is a resident in a waiver program’s residential facility,

the facility must continue to offer the same services to the individual that

elects the hospice benefit. The hospice member should not experience

any lack of facility services because of his/her status as a hospice

member.