Hospice Eligibility Criteria
In order for a Medicaid beneficiary to qualify for hospice care under Medicaid, a beneficiary must:
- Be certified by a doctor as having a terminal illness.
- Have a medical prognosis that his/her life expectancy is six months or less if the disease runs its normal course.
- Hospice FAQs
Where do I mail Hospice Election/Discharge Forms?
SCDHHS
1801 Main Street
Attn: 9th Floor Hospice
Columbia, SC 29202
“It’s crucial that I get these forms to you ASAP”
They can be faxed to 803-255-8209, or scanned and emailed to HospiceForms@scdhhs.gov.
Where do I mail paper claims?
Medicaid Claims Receipt
P.O. Box 1412
Columbia, SC 29202-1412
“Can you check on the status of a patient? (AKA, has a beneficiary’s info been entered in MMIS?)
In MMIS, first select “Recipient Information”, then mark “Recipient Retrieval (RCP#)” and enter the beneficiaries Medicaid ID #. Press enter. Press F3 while in the beneficiary’s information screen to bring up the RSP screen. Half way down the screen, you will see a list of dates of service and programs the beneficiary is enrolled in (or nothing if the beneficiary isn’t enrolled or has never been enrolled). Under “PROV#”, look for HSP### (HSP = Hospice, ### = Provider ID). Compare the information in MMIS with the information given on the phone. If they do not match (or MMIS shows no enrollment), ask the provider to mail in the Election and/or Discharge forms.
If they patient was authorized through KePRO and does not appear in MMIS, record the Medicaid ID # and provider’s phone # for the program coordinator, who will update MMIS with the information on return.
Questions relating to billing status, such as “How can I check on if my claims were received?”
While the Hospice Program Coordinator is absent, all claim status questions should be directed toward the Provider Service Center at 1-888-289-0709
Where can I find the current hospice rates?
Hospice rates can be found on the SCDHHS (scdhhs.gov) website if you follow this: Under the “For Providers” dropdown menu, select “Provider Areas”, on the next screen, select “Division of Community and Facility Services”, on the next screen, select “Hospice”, on the next screen the hospice rates can be found (in PDF format) under “Reimbursement”.
How can I contact KePRO concerning a Prior-authorization request?
- KePRO Customer Service Phone number: 1-855-326-5216
- KePRO Fax number: 1-855-300-0082
- KePRO Provider Issues email: atrezzoissues@kepro.com
Can a beneficiary have Community Long Term Care (CLTC) and Hospice at the same time?
Yes, but when enrolled in both, CLTC will only reimburse for Case Management, Home Delivered Meals and PERS (aka, emergency medical devices like Life Line). All other services formally provided by CLTC will be provided for by the hospice.
Our patient does not have Medicaid or is in a Medicaid Pay Category that does not cover hospice. (This will usually say “Recipient is only eligible for family planning services” in the Recipient Information Screen)
Inform the provider that the beneficiary or a beneficiary representative needs to contact the Medicaid Eligibility office in the beneficiary’s county of permanent residence.
- Hospice Reimbursements
Rates
Hospice Rates by County (PDF)
- FY 10/23 - 09/24
- FY 10/22 - 09/23
- FY 10/21 - 09/22
- FY 10/20 - 09/21
- FY 10/19 - 09/20
- FY 10/18 - 09/19
- FY 10/17 - 09/18
- FY 10/16 - 09/17
- FY 10/15 - 09/16
- FY 10/14 - 09/15
Paper Claim Submission of Claim Form CMS-1500
Mail to Medicaid Claims Receipt at: Medicaid Claims Receipt, P.O. Box 1412, Columbia, SC 29202-1412
Billing for Dually Eligible Recipients
When a beneficiary has both Medicare and Medicaid, Medicare is the primary payer. Services rendered to persons who are certified dually eligible for Medicare/Medicaid must be billed to Medicare first. See the Hospice Provider Manual.
Medicaid Recipient Eligibility
To check Medicaid eligibility: call 1-800-809-3040 or use the Web Tool.
Hospice Eligibility
In order for a Medicaid beneficiary to be eligible to elect hospice care under Medicaid, he or she must be certified as being terminally ill. An person is considered terminally ill if he or she has a medical prognosis that his or her life expectancy is six months or less if the disease runs its normal course.