Provider Notice issued 06/27/12

Non-Coverage of Specified Services for Hospice-Enrolled Participants

As a result of Public Act 097-0689(pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, HFS is implementing the following changes to benefits for patients electing coverage under the Medicaid hospice benefit.

Effective with dates of service on and after July 1, 2012, the following services will no longer be covered for non-hospice providers serving patients enrolled in the department’s hospice program. These restrictions do not affect the services provided and billed by the hospice agency.

• Dental Services

• Optometric Services and Eyewear

• Nursing Services Provided by Registered Nurses and Licensed Practical Nurses

• Occupational, Physical, and Speech Therapy Services

• Audiology Services

• General Clinic Services

• Hospital Psychiatric Clinic Type A and Type B Services

• Hospital Outpatient Physical Rehabilitation Services

• Healthy Kids Services

• Early Intervention Services

• Mental Health Rehabilitation Option Services

• Alcohol and Substance Abuse Rehabilitation Services

• Medical Equipment and Supplies

• Medicar, Taxicab, Service Car, and Private Auto Transportation Services

• Social Work and Psychologist Services

• Home Health Services

• Homemaker Services

• Palliative Drugs

Note: Physician and nurse practitioner services will be reimbursed only if the provider identifies the service as not related to the terminal illness by using the “GW” modifier with the procedure code billed.

Institutional providers who submit claims for an eliminated service will receive error code R89, Invoice Invalid for Hospice Patient. Non-institutional providers who submit claims for an eliminated service will receive error code G52, Hospice – Inappropriate Bill.

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs