N.C. Medicaid Clinical Coverage Policy No. 3D § 5.10

The provider of hospice services shall comply with 42 CFR §418.24, Election of hospice

care.

A Medicaid beneficiary who elects the hospice benefit waives the rights to Medicaid

coverage of other services that replicate the services covered under the hospice benefit.

The waiver of curative services is not applicable to beneficiaries under 21 years old. Refer

to Subsection 5.11. The written statement contains the waiver of coverage for certain

Medicaid or covered services when they are pertinent to treatment of the terminal illness.

The waived Medicaid services are listed below for beneficiaries 21 and under: (Refer to

Subsection 5.11):

a. Medicaid coverage for home health, Durable Medical Equipment (DME), and home

infusion therapy (HIT) services is not allowed for a hospice beneficiary when the

service pertains to the treatment of the terminal illness or related conditions.

b. Drugs and biologicals pertaining to the terminal diagnosis are reimbursed to the

hospice as part of the hospice per diem. Medicaid shall make direct reimbursement to

the pharmacy for drugs used to treat illnesses or conditions not related to the terminal

illness.