Hospice Eligibility Criteria
In order for a Medicaid member to qualify for hospice care under Medicaid, a member must:
- Be certified by a doctor as having a terminal illness.
- Have a medical prognosis of a life expectancy that is six months or less if the disease runs its normal course.
To check Medicaid eligibility: call 1-800-809-3040 or use the Web Tool.
- Hospice FAQs
Where do I mail Hospice Election/Discharge Forms?
SCDHHS
1801 Main Street
Columbia, SC 29202
Attn: 9th Floor HospiceWhere can I fax or email my forms?
They can be faxed to 803-255-8209, or scanned and emailed to HospiceForms@scdhhs.gov .Where do I mail Paper Claim Submission of Claim Form CMS-1500?
Medicaid Claims Receipt
P.O. Box 1412
Columbia, SC 29202-1412How can I check on if my claims were received?
All claim status questions should be directed toward the Provider Service Center at 1-888-289-0709.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 member 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.How are services billed for dual eligible members?
When a member 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.- Hospice Reimbursement Rates
Hospice Rates by County (PDF)