Wash. HCA Hospice Services Billing Guide, Who is eligible for Pediatric Palliative Care (PPC) services?

To receive PPC case management/coordination services, a person must:

• Be age 20 or younger.

• Be covered by a benefit package that covers PPC case

management/coordination services. See HCA’s ProviderOne Billing and

Resource Guide for instructions on how to verify a client’s eligibility.

• Have a life-limiting medical condition with a complex set of needs requiring

case management and coordination of medical services due to at least three

of the following six circumstances:

o An immediate medical need during a time of crises

o Coordination with family member(s) and providers required in more than

one setting (i.e., school, home, and multiple medical offices or clinics)

o A life-limiting medical condition that impacts cognitive, social, and physical

development

o A medical condition in which the family is unable to cope

o A family member(s) or caregiver, or both, who needs additional knowledge

or assistance with the client’s medical needs

o Therapeutic goals focused on quality of life, comfort, and family stability

Note: See the Program Benefit Packages and Scope of Services

table for an up-to-date listing of benefit packages.

Note: Pediatric palliative care (PPC) case management/

coordination services allow, up to six pediatric palliative care

contacts per client, per calendar month, without prior

authorization, subject to WAC 182-551-1820 and WAC 182-501-

0169.