N.C. Medicaid Clinical Coverage Policy No. 3D § 1.0

The NC Medicaid (Medicaid) hospice benefit is a comprehensive set of services, identified and

coordinated by a hospice interdisciplinary group (IDG). The IDG delivers medical, nursing, social,

psychological, emotional, and spiritual services to enable physical and emotional comfort and

support using a holistic approach to maintain the best quality of life for a terminally ill beneficiary,

their family, and caregivers. The priority of hospice services is to meet the needs and goals of the

hospice beneficiary, family, and caregivers with daily activities and to help the terminally ill

beneficiary with minimal disruption to normal activities, in the environment that best meets the

care and comfort needs of the beneficiary and unit of care.

The hospice IDG achieves this by organizing and managing a comprehensive care plan focused on

coordinating care, services and resources to the beneficiary, caregivers, and family necessary for

the palliation and management of the terminal illness and related conditions.

Only Medicare-certified and North Carolina licensed hospice agencies are eligible to participate as

Medicaid hospice providers through the NC Division of Health Service Regulation

(www.ncdhhs.gov). Each site providing hospice services must be separately licensed. The North

Carolina Medical Care Commission has rulemaking authority for hospice. The statutes that apply

to hospice agencies are General Statute 131E-200 through 207 and the licensure rules are under

Title 10A of the North Carolina Administrative Code (10A NCAC 13K); (G.S. 131E, Article 9,

175-190) and administrative rules (10A NCAC Subchapter 14C).

A Hospice provider must have a contract with a nursing home or hospital if services are provided

within those facilities.

Note: Throughout this policy, wherever the word “family” is used, “caregivers” are included

unless specifically stated otherwise.