N.H. Medicaid Hospice Provider Manual, Vol. II, § 4

Non-covered services are services for which NH Medicaid will not make payment.

There may be non-covered services directly associated with your provider type (such as those listed

below or those for which there is no medical need), but some non-covered services cannot be directly

associated with a specific provider category. Therefore, providers should review the list of other examples

of non-covered services in the “Non-Covered Services” section of the General Billing Manual – Volume

I.

If a non-covered service is provided to a member, the provider must inform the member, prior to delivery

of the service, that it is non-covered by NH Medicaid, and that, should the member still choose to receive

the service, the member will be responsible for payment. If this occurs, the Department recommends that

the provider maintain in their files a statement signed and dated by the member that indicates that the

member understands that the service is non-covered and that s/he agrees to pay for the service.

Upon election of hospice care the member agrees to waive all rights to the following Medicaid Services:

1. Hospice care provided by a hospice other than the one designated by the member on the hospice

care provider’s hospice election form, unless provided under arrangements made by the

designated hospice;

2. NH Medicaid services that are:

a. Related to the treatment of the terminal illness for which hospice care was elected;

b. Related to the treatment of a condition or complication related to the terminal illness for

which hospice care was elected; or

c. Equivalent to, or duplicative of, hospice services; and

3. NH Medicaid Home and Community-based Care Waiver Services that are equivalent to or

duplicative of, hospice services.

Members under the age of 21 are not required to waive rights to Medicaid services related to treatment of

the member’s condition for which a diagnosis of terminal illness has been made.