Va. DMAS Hospice Provider Manual ch. IV, Individuals Receiving Hospice Services While Residing In Dedicated Hospice Facilities

If an individual is admitted to a dedicated hospice facility under the hospice benefit,

preadmission screening is not required. The facility shall provide 24-hour nursing

services sufficient to meet the total nursing needs of those its care. This includes

treatment, medication, and diet, as prescribed, as well as keeping individuals comfortable,

well-groomed, and protected from accident, injury, and infection.

Individuals residing in dedicated hospice facilities are not eligible to receive CCC Plus

waiver services, as facility staff are required to meet the needs of persons residing in the

facility.

PEDIATRIC CONCURRENT CARE

Under Federal requirements DMAS must cover concurrent care for children under the

age of 21. Concurrent curative care is covered outside of the hospice benefit when the

child is enrolled in Medicaid FFS, or a Cardinal Care plan (FAMIS only). Those children

who are enrolled in a Cardinal Care plan (that is a non-FAMIS plan) and elect hospice

will be moved out of the Cardinal Care plan and moved into Medicaid FFS the day before

the hospice benefit is elected.

Those receiving pediatric concurrent care do not have to be discharged from hospice to

receive concurrent curative care. Concurrent care would be covered under the regular

Medicaid benefit or waiver services. Coordination of care is an important piece in the

management of these cases. The hospice provider, care coordinator (for MCO plans)

and the treating providers should work together as much as possible to make sure

everyone one involved in the childs care has accurate information.

Normal procedures for curative care shold be followed even though the child in enrolled

in hospice. Providers will need to seek service authorization for concurrent care if it

required. For Medicaid FFS members see the published manuals on our website for

guidelines and service authorization requirements. Provider should refer to the individual

Cardinal Care plan guidelines for members enrolled in one of the MCO plans. It is

important for those enrolled in an MCO plan to work with the care coordinator for the

Medicaid member to coordinate care.

Some examples of pediatric concurrent care include (but are not limited) to the following:

• A child who has elected hospice care at home and needs 24 hour

mechanical ventilation and also needs a speciality wheelchair to

accommodate the ventilator and their functional limitations in order for the

child to be mobile for doctor’s visits, movement around the home and

community.

• A child with a diagnosis of cancer whose family has elected hospice but is

actively still seeking treatment for cancer. The cancer treatment may

include specialty doctor’s visits and inpatient or outpatient treatments.

• A child who is on the waiting list for a lung transplant, whose family elected

the hospice benefit. The child is actively seeking curative treatment and is

seeing several specialist for care.