N.C. Medicaid Clinical Coverage Policy No. 3D § 3.2.1

Medicaid shall cover the following hospice services when medically necessary

and the criteria and requirements are met according to:

42 CFR §418 – Hospice Care, Subpart C-Conditions of Participation: Patient

Care, and Subpart F- Covered Services.

These services must be provided in a manner consistent with acceptable standards

of practice:

a. Nursing services according to 42 CFR §418.202(a);

b. Medical social services according to 42 CFR §418.202(b);

c. Physicians' services according to 42 CFR §418.202(c);

d. Counseling services (bereavement, dietary, and spiritual) services according to

42 CFR §418.202(d);

e. Short-term inpatient care;

f. Interdisciplinary group, care planning, and coordination of services according

to 42 CFR §418.56;

g. Medical appliances and supplies, including drugs and biologicals according to

42 CFR §418.202(f)

h. Hospice aide and homemaker services according to 42 CFR §418.202(g);

i.

Physical therapy, occupational therapy and speech-language pathology

services according to 42 CFR §418.202(h);

j.

Volunteer services according to 42 CFR §418.78; and any other service that is

specified in the beneficiary’s plan of care as reasonable and necessary for the

palliation and management of the patient's terminal illness and related

conditions and for which payment may otherwise be made under Medicaid

according to 42 CFR §418.202(h)(i).

In addition to the above covered services, Medicaid shall cover ambulance

transport services when provided in relation to the palliation or management

of the beneficiary’s terminal illness which occur after the effective date of

election.