N.C. Medicaid Clinical Coverage Policy No. 3D § 7.3.3.1

Hospice services may be provided for a Medicaid beneficiary residing in

an adult care home (ACH) when the beneficiary elects the hospice benefit.

The ACH and the hospice provider shall have a written contractual

agreement that describes the services to be provided by each per the plan

of care. The ACH is considered the beneficiary’s place of residence and

the basic care is provided by the ACH staff.

The hospice provider has the responsibility for the professional

management of the beneficiary’s care. The hospice provider is responsible

for the oversight of the beneficiary’s medical care and the monitoring of

the care provided by the facility to ensure adequacy of care provision and

the need for changes to the services and the plan of care. The plan of care

includes the services provided by both the ACH (that is, room and board,

ACH Personal Care Services) and the hospice provider (that is, other

services related to the terminal illness). The hospice provider is

responsible for coordinating all services included in the plan of care. A

copy of the hospice plan of care is provided to the ACH.