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Hospice Benefits

The Hospice benefit is an optional state plan service that includes an array of services furnished to terminally ill individuals. These services include: nursing, medical social services, physician services, counseling services to the terminally ill individual and the family members or others caring for the individual at home, short-term inpatient care, medical appliances and supplies, home health aide and homemaker services, physical therapy, occupational therapy and speech-language pathology services. 

Individuals must elect the hospice benefit by filing an election statement with a particular hospice. They must acknowledge that they understand that other Medicaid services for the cure or treatment of the terminal condition are waived. Individuals may, however, revoke the election of hospice at any time and resume receipt of the Medicaid-covered benefits waived when hospice was elected. 

A hospice provider must obtain a physician certification that an individual is terminally ill and hospice services must be reasonable and necessary for the palliation or management of the terminal illness and related conditions. A hospice plan of care must be established before services are provided.

Categories or levels of hospice care include:

  1. Routine Home Care (RHC)
  2. Continuous Home Care (CHC), which is furnished during a period of crisis and primarily consists of nursing care
  3. Inpatient Respite Care (IRC), which is short-term care and intended to relieve family members or others caring for the individual
  4. General Inpatient Care (GIC), which is short term and intended for pain control or acute or chronic symptom management which cannot be provided in other settings
  5. Service Intensity Add-On when the following criteria are met:
    1. The day on which the services are provided is an RHC level of care
    2. The day on which the service is provided occurs during the last seven days of life, and the client is discharged deceased
    3. The service is provided by a registered nurse or social worker that day for at least fifteen minutes and up to four hours total
    4. The service is not provided by the social worker via telephone

The national hospice reimbursement rates for these four levels of care change annually and are based on the annual Medicare hospice updates. For more information on Medicaid hospice reimbursement, please go to the Medicaid Hospice Payments page.

Beginning March 23, 2010, with the enactment of the Affordable Care Act, Medicaid and CHIP-eligible individuals under age 21 who elect the hospice benefit no longer have to waive services for the cure or treatment of the terminal condition and can receive both curative care and hospice care for the terminal condition.