N.Y. Medicaid Hospice Program Manual Policy Guidelines, Section I, Medicaid Coverage

The Medicaid hospice benefit includes all services necessary to meet the needs of the

patient related to the terminal illness. It is the responsibility of the hospice to provide

those services required under the Medicaid hospice benefit.

Medicaid hospice services required by federal regulations are:

• nursing and physician services

• medical social services

• nutrition counseling

• spiritual and bereavement counseling

• home health aide

• homemaker services

• volunteer services

• medical supplies and appliances

• physical therapy

• occupational therapy

• speech therapy

• short-term inpatient care

Personal Care Services (PCS) and Consumer Directed Personal Assistance

Services (CDPAS), above those provided by Hospice, may be authorized by the

local department of social services/managed care organization only if:

• determined necessary and part of the plan of care unrelated to the terminal

illness, or

• services preceded the terminal illness and

• the individual meets the PCS eligibility criteria.

Medicaid reimburses for hospice care as follows:

• For routine home care, including personal care services, using an all-inclusive

daily reimbursement rate;

• Continuous home care during periods of crisis;

• General inpatient care for pain or symptom management;

• Inpatient respite to relieve caregivers; and

• Room and board for individuals receiving hospice care in a skilled nursing facility

or hospice residence.