R.I. Medicaid Provider Manual, Hospice Services 300-20, Inpatient Care

In addition to basic Hospice Services, short-term inpatient care may be provided in a hospice inpatient unit, general inpatient hospital, or a nursing facility.

Two levels of inpatient care are covered and must conform to the written plan of care:

General Inpatient Care:

Medicaid Hospice General Inpatient care must meet Federal and State requirements for appropriate care level and document that the beneficiaries’ need for pain and symptom management is beyond the routine care level. Beneficiaries should be evaluated on a case-by-case basis- but in general may be admitted for short-term General Inpatient Care when the physician and Hospice Interdisciplinary Team believes the beneficiary needs pain control or symptom management that cannot feasible be provided in other settings. Also the beneficiary must require an intensity of skilled nursing care by a Registered Nurse and frequent skilled nursing intervention on all three shifts directed toward pain control and symptom management.

All General Inpatient admissions and continued stays will require a prior authorization. All Fee-for-Service Medicaid inpatient Hospital stays will be authorized by Qualidigm. All others will require the current Prior Authorization process in place through HP, our fiscal agent.

Respite care may also be furnished to provide respite for the individual's family or other persons caring for the individual in their home.

A hospice provider may not arrange to provide inpatient services to Medical Assistance Program recipients in a VA or military hospital because the Medical Assistance Program cannot pay for services that another government agency has paid or is obligated to pay.