Kan. Medical Assistance Program Hospice Fee-for-Service Provider Manual § 8400, Hospice Care for Children in Medicaid

Members receiving services reimbursed by Medicaid and Children’s Health Insurance Program (CHIP)

can continue medically necessary curative services, even after the election of the hospice benefit by or on

behalf of children receiving services. Section 2302 of the Affordable Care Act, entitled “Concurrent Care

for Children,” allows curative treatment upon the election of the hospice benefit by or on behalf of

children enrolled in Medicaid or CHIP.

The Affordable Care Act does not change the criteria for receiving hospice services. Prior to the

enactment of the new law, curative treatment of the terminal illness ended upon election of the hospice

benefit. This new provision requires states to make hospice services available to children eligible for

Medicaid and Medicaid-expansion CHIP programs without terminating any other service which the child

is entitled to under Medicaid for treatment of the terminal condition.

Limitations

Concurrent hospice care for children will be covered for the duration needed. An individual may

elect to receive hospice care during one or more of the following election periods:

• An initial 90-day period

• A subsequent 90-day period

• Unlimited subsequent 60-day periods with appropriate physician recertification for continued

hospice care

Medical services and concurrent care for children receiving hospice services

Children receiving hospice services can continue to receive other reasonable and necessary medical

services, including curative treatment for the terminal hospice condition.

• PA is required.

• Hospice providers will be responsible for coordinating all services related to the hospice

diagnosis and assisting nonhospice providers to obtain authorization for services not related

to the hospice diagnosis.

• Hospice providers will be responsible for all durable medical equipment, supplies, and

services related to the hospice diagnosis.

• Nonhospice providers must first communicate and coordinate with hospice providers

regarding needed services or procedures prior to rendering concurrent care for children.

• Nonhospice providers must bill hospice first to receive a payment or denial for the service

provided.

• If payment is denied by hospice, nonhospice providers must submit a paper claim,

documentation of medical necessity and the hospice denial form to the PA department

for review.

• If PA cannot be obtained prior to rendering services to children, providers may be allowed a

backdated approval for services upon submission of a paper claim for the service with

documentation attached to support medical necessity and hospice denial of the service.

Hospice patients (0 through 20 years of age) can receive the services identified below as long as the

services are not duplicative of services provided by the hospice facility.

• Case management services when provided and billed by an APRN enrolled in KMAP

• Technology Assisted (TA) waiver program attendant care services

Note: Hospice providers will continue to be responsible for all durable medical equipment

and supplies.

Hospice Attending Physician Services for RHCs and FQHCs

Effective with dates service on and after January 1, 2022, Rural Health Centers (RHCs) and/or

Federally Qualified Health Centers (FQHCs) can bill and receive payment under the RHC/ FQHC

Prospective Payment System (PPS) when a designated attending physician employed by or working

under contract with the RHC or FQHC furnishes hospice attending physician services.

To receive payment under the RHC and FQHC PPS, the RHC or FQHC must report the GV modifier

(attending physician not employed or paid under the arrangement by the patient's hospice provider)

when a physician, nurse practitioner (NP), or physician assistant (PA) employed by or working under

contract with an RHC or FQHC furnishes hospice attending physician services to a member that has

elected hospice.

• The RHC/FQHC must report the GV modifier on the claim line with the payment code each day a

hospice attending physician service is furnished.

• If the RHC/FQHC providing hospice attending physician services submits a claim without the GV

modifier, the claims will be denied.

• If the RHC/FQHC providing hospice attending physician services submits a claim with modifier

GV for a non-hospice member, the claim will be denied.

Approved CPT Codes:

99212 99213 99214 99215 99307 99308 99309 99310

99334 99335 99336 99337 99347 99348 99349 99350