Wash. HCA Hospice Services Billing Guide, Do children who are hospice care clients have access to concurrent life prolonging and curative services?

Yes. In response to the Patient Protection and Affordable Care Act, clients age 20

and younger who are on hospice services also have access to curative services.

Note: The legal authority for these clients’ hospice palliative

services is in Section 2302 of the Patient Protection and

Affordable Care Act of 2010 and Section 1814(a)(7) of the Social

Security Act; and for a client’s curative services is Title XIX

Medicaid and Title XXI Children's Health Insurance Program

(CHIP) for treatment of the terminal condition.

Concurrent care treatment – life prolonging/curative

treatment

Unless otherwise specified within this billing guide, concurrent - life

prolonging/curative treatment, related services, or related medications requested

for clients age 20 and younger are subject to HCA’s specific program rules

governing those services or medications.

A client age 20 and younger may voluntarily elect hospice care without waiving

any rights to services that the client is entitled to under Title XIX Medicaid and

Title XXI Children’s Health Insurance Program (CHIP) that are related to the

treatment of the client’s condition for which a diagnosis of terminal illness has

been made.

EPA # Criteria

870001409 Children 20 years old or younger - enrolled in hospice with or

without concurrent care treatment. Hospice agencies will remain

and are responsible for symptom control related to the child’s

terminal illness. See WAC 182-551-1210 to see what is included

in the hospice daily rate.

Note: If billing with EPA 870001409, the Hospice Indicator will

not be listed on the client’s file in ProviderOne.

Note: If a noncovered service is recommended based on the

early and periodic screening, diagnosis, and treatment (EPSDT)

program, HCA evaluates the request for medical necessity based

on the definition in WAC 182-500-0070 and the process in WAC

182-501-0165.

If HCA denies a request for a covered service, refer to WAC 182-

502-0160 that specifies when a provider or a client may be

responsible to pay for a covered service.

Services that are the hospice agency's responsibility

The following services are to be provided by the hospice agency in accordance

with current guidelines, while the client is receiving concurrent care:

• Hospice covered services as described in WAC 182-551-1210

• Services rendered for symptom management, including but not limited to:

o Medications (e.g., pain management, nausea, vomiting, anxiety)

o Equipment and related supplies

• Ancillary services, such as medical transportation (e.g., provider appointment,

laboratory and other testing)