Hospice Care

Program Coverage:

Hospice care is a form of medical multidisciplinary care that addresses the unique requirements of terminally ill individuals. Hospice is used to alleviate pain and suffering, and treat symptoms rather than to cure the illness. Medical and nursing services are designed to maximize the patient’s comfort, alertness and independence so the patient can reside in the home as long as possible. Providers must enroll as a Medi-Cal hospice provider. All claims are submitted using the UB-04 claim form.

Hospice providers may include the following:

Hospitals
Skilled nursing facilities
Intermediate care facilities
Home health agencies
Any licensed health provider who has been certified by Medicare to provide hospice care and is enrolled as a Medi-Cal hospice care provider.

Note: All services must be rendered in accordance with Medicare requirements. Hospice is a covered optional benefit under Medi-Cal with two 90-day periods, beginning on the date of hospice election, followed by unlimited 60-day periods.

Hospice Care Eligibility:

Any Medi-Cal recipient certified by a physician as having a life expectancy of six months or less may elect to receive hospice care in lieu of normal Medi-Cal coverage for services related to the terminal condition. Election of hospice care occurs when the patient (or representative) voluntarily files an election statement with the hospice provider. This statement acknowledges that the patient understands that the hospice care relating to the illness is intended to alleviate pain and suffering rather than to cure the illness and that certain Medi-Cal benefits are waived by this election.