Ala. Admin. Code r. 560-X-51-.01

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-51-.01 - Hospice Care - General

(1) Hospice care services are available if medically necessary for full Medicaid eligible recipients certified as being terminally ill. Medical certification is required by the individual's attending physician; however, if the recipient does not have a primary attending physician, certification may be given by the Hospice Team physician or the hospice medical director. Certification of the terminal illness of an individual who elects hospice shall be based on the attending physician, hospice team physician, or hospice medical director's clinical judgment regarding the normal course of the individual's illness. Certification of terminal illness must include specific findings and other medical documentation including, but not limited to, medical records, lab x-rays, pathology reports, etc. Hospice care means services which are necessary for the palliation or management of the terminal illness and related conditions.

(2) Alabama Medicaid Hospice Care services are subject to Medicare special election periods applicable to hospice care.

Medicaid will utilize the most recent benefit periods established by the Medicare Program.

Ala. Admin. Code r. 560-X-51-.01

Emergency Rule effective October 1, 1990. Permanent Rule effective February 13, 1991. Emergency Rule effective May 15, 1991. Amended: effective August 14, 1991. Amended: Filed August 4, 1998; effective September 9, 1998. Amended: Filed May 16, 2001; effective June 20, 2001. Amended: Filed August 9, 2012; effective September 13, 2012.

Author: Felicia Fisher, Administrator, LTC Provider/Recipient Services Unit, Long Term Care Division

Statutory Authority: Title XIX, Social Security Act; 42 C.F.R. § 418.20; State Medicaid Manual; State Plan.