Provider Notice issued 12/11/12

Concurrent Palliative and Curative Care for Children Receiving the Hospice Benefit

This notice serves to inform providers of coverage changes for children receiving the hospice benefit under the department's Medical Programs.

Section 2302 of the Affordable Care Act, titled "Concurrent Care for Children," amends sections 1905(o)(1) and 2110(a)(23) of the Social Security Act to remove the prohibition of receiving curative treatment upon election of the hospice benefit for a Medicaid or Children's Health Insurance Program (CHIP) eligible child.

Effective July 1, 2012, Public Act 097-0689(pdf), referred to as the Save Medicaid Access and Resources Together (SMART) Act, restricted the services hospice patients could receive outside of the hospice benefit. This policy is rescinded for children through age 20, and the department will allow access to all curative treatment the patient may wish to obtain.

This policy does not change the criteria for electing the hospice benefit, nor change the process for hospitals to contact the hospice regarding payment of hospital admissions. As denoted in the Handbook for Hospice Agencies, topic K-234.1, if a hospice patient is admitted as an inpatient and the admission is related to the terminal illness, the hospice is responsible for payment of the inpatient stay. If the hospice patient is admitted and the admission is not related to the terminal illness, the department will adjudicate the inpatient claim for payment only if there is a payment denial letter from the hospice attached to the inpatient claim.

Questions regarding this notice may be directed to a hospice billing consultant in the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs