Mich. Medicaid Provider Manual, Hospice § 6.8

Children under 21 years of age may receive hospice care concurrently with curative treatment of the

child’s terminal illness. This allows the beneficiary or beneficiary’s representative to elect the hospice

benefit without forgoing any curative service to which the child is entitled under Medicaid for treatment of

the terminal condition. The need for hospice care must by certified by a physician and the hospice

medical director.

Under concurrent curative care policy, curative care is defined as medically necessary care that serves to

eliminate the signs and symptoms of a disease with the goal of a cure or long-term disease-free state.

Medicaid will reimburse for the curative care separately from the hospice services. Medicaid will not

reimburse for these types of treatments when they are used palliatively. Palliative care under hospice is

defined as an active patient and family-centered interdisciplinary approach to pain and symptom

management of the terminal illness. Palliative care is always a part of hospice and included in the

hospice per diem reimbursement. The term "palliative care" cannot be separately billed or reimbursed by

Medicaid.

A child receiving hospice will continue to receive appropriate early and periodic screening, diagnosis and

treatment (EPSDT) services to the extent these services are medically necessary.

Pediatric Subspecialist A pediatric subspecialist must direct the curative care related to the beneficiary’s

terminal diagnosis. For purposes of this policy, a pediatric subspecialist is a physician or

permitted NPP who is board certified, or board eligible for subspecialty certification, in a

pediatric subspecialty including, but not limited to, neurology, cardiology, pulmonology,

endocrinology, or oncology. In most cases, a general pediatrician will not be considered

a pediatric subspecialist relative to this policy, but a general pediatrician may assume the

role of pediatric subspecialist and direct the child’s curative care if they have acted as

the primary care provider and treated the child’s terminal condition prior to the election

of hospice. NOTE: Beneficiaries with CSHCS-only coverage, meaning no Medicaid

coverage and receiving hospice related to the CSHCS qualifying condition, must have a

pediatric subspecialist for that condition manage the concurrent curative treatment of

the terminal condition.

Coordination of Care The hospice provider and pediatric subspecialist must work together to ensure a

collaborative approach to the care of the beneficiary. The hospice Plan of Care (POC)

must demonstrate coordination of care between the hospice and the pediatric

subspecialist. It is the responsibility of each provider working collaboratively to

determine whether a service is curative or palliative (hospice). The hospice record must

contain a signed statement or attestation from the pediatric subspecialist explaining the

course of treatment and acknowledging the physician is aware the beneficiary is

receiving hospice services concurrently with curative treatment. The attestation must be

dated and present in both the hospice and pediatric subspecialist records within 30 days

after the beneficiary is admitted into hospice. The signature, printed name, and National

Provider Identifier (NPI) number of the physician ordering and coordinating the

concurrent curative treatment must be documented on the attestation. For a beneficiary

enrolled in a Medicaid Health Plan (MHP), the hospice provider and pediatric

subspecialist must also work with the MHP to ensure that the MHP authorization and

documentation requirements are met.

Billing and

Reimbursement

Hospice services and curative treatment are billed and reimbursed separately under this

policy. Prior to billing, it is important that providers differentiate between services that

are palliative and therefore included in hospice reimbursement, and those that are

curative and separately reimbursable under Medicaid. MDHHS recognizes the challenge

this poses for providers, and each child’s circumstances will need to be taken into

consideration when making this distinction. The table below provides examples of

treatment and related service categories but is not all-inclusive or intended to represent

fixed parameters for decision making. Caution should be taken to avoid billing both the

hospice and Medicaid for the same service as this represents double billing and may

constitute fraud.

Examples of Treatment and Service Categories

Treatment Hospice

Service

Concurrent

Curative

Service

Both Hospice

and Concurrent

Curative

Services

Comments

Pain/Symptom

Management

Narcotics, Analgesics X

Antiemetics X

Nutrition

Tube Feeding

X Hospice = Continuation of

previous tube feedings.

Concurrent = Tube placement;

initiating feedings.

Intravenous (IV) Fluids

X

Concurrent = Surgical central

line placement

Total Parenteral Nutrition

(TPN)

X

Respiratory Support

Oxygen X

Bilevel Positive Airway

Pressure (BiPAP)

X Hospice = <72 hrs.

Concurrent = Acute event not

related to terminal illness

Continuous Positive Airway

Pressure (CPAP)

X

Ventilator

X

Treatment Hospice

Service

Concurrent

Curative

Service

Both Hospice

and Concurrent

Curative

Services

Comments

Respiratory Vests

X

Cough Assist Device(s)

X

Pharmacy

Antibiotics X

Antibiotic administration through

available access

Chemotherapy

X

Intravenous immunoglobulin

X

Blood Products

X

Supports

Spiritual Support X

Psychological/Social Support X

Bereavement Support X

Radiation

X

Durable Medical

Equipment (DME)

Specialized Seating

X

Wheelchairs X