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TO:     All Providers

RE: Concurrent/simultaneous services from Hospice and a Home and Community Based Services waiver

The Alabama Medicaid Agency (Medicaid) updated the policy to allow concurrent services from hospice and a Home and Community-Based Services (HCBS) Waiver. However, it is vital that the hospice and HCBS waiver case manager coordinate to avoid duplication of services.

The HCBS waiver person-centered care plan (PCCP) and hospice plan of care (POC) of the recipient should be coordinated between the hospice, HCBS waiver case manager, and the recipient and his/her caregiver. A conference that includes these parties must be held before concurrent services can start.  The PCCP/POC conference shall be documented in both the recipient’s hospice and waiver record. The PCCP/POC should specify all concurrent services, the frequency of services, and which entity will provide the service. Each HCBS Waiver service included in the PCCP/POC should have an explanation as to why the service is not covered under hospice.

Communication and coordination shall be ongoing and should occur on a frequent basis. Written documentation in the recipient’s hospice and waiver record should reflect the communication and coordination.

As hospice is a State Plan service, hospice benefits shall be fully utilized prior to waiver services to avoid duplication. Hospice is responsible for all services related to the recipient’s terminal illness. Both providers are subject to retrospective reviews of hospice and HCBS waiver services. If duplication of services is found, Medicaid may recover improper payment.

The fiscal agent is working on system changes to allow both providers to submit claims electronically. Until this is complete, the hospice provider will submit hard copy claims for payment.

Send the claims to:

Alabama Medicaid Agency

P.O. Box 5624

Montgomery, AL 36103

Attn: Robin Arrington – Long Term Care Division

Examples of potentially duplicative services may include, but are not limited to:

•         Hospice aide & HCBS personal care aide at the same time.

•         Hospice medical supplies & HCBS specialized medical equipment.

•         Hospice nursing care & HCBS Waiver skilled nursing at the same time.

If you have questions, email Cheryl.cardwell@medicaid.alabama.gov or Jessie.burris@medicaid.alabama.gov.