Medicaid Benefits: Hospice Care

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2018

Location	Benefit Covered	Coverage Code	Copayment Required?	Limits on Services	Prior Approval Required	Reimbursement Methodology
United States	Yes - 46 No - 0 NR - 5	2018 data limited to CN	Yes - 4	Yes - 18	Included in "Limits on Services" for 2018	Not included in 2018 survey
Alabama	Yes	CN	Patient Liability for Nursing Facility Residents	No	-	-
Alaska	Yes	CN	No	Prior authorization Required	-	-
Arizona	Yes	CN	No	Terminally ill	-	-
Arkansas	Yes	CN	NR	NR	-	-
California	Yes	CN	No	No	-	-
Colorado	Yes	CN	No	Clients must be certified as terminally ill with a life expectancy of 9 months or less	-	-
Connecticut	Yes	CN	No	Medical care for terminal illness will be not covered for members, 19 years and older. Members must have a life expectancy is 6 months or less to be eligible for hospice services. Hospice services certified for 90 days initially and 90-day increments thereafter.	-	-
Delaware	Yes	CN	No	No	-	-
District of Columbia	Yes	CN	No	Requires certification of life expectancy of six months or less	-	-
Florida	Yes	CN	Recipients are responsible for paying patient responsibility share that is calculated based on income.	No	-	-
Georgia	Yes	CN	Estate Recovery for estates larger than $25,000.	NR	-	-
Hawaii	Yes	CN	No	No	-	-
Idaho	Yes	CN	No	No	-	-
Illinois	NR	NR	NR	NR	-	-
Indiana	Yes	CN	No	Prognosis of 6 months or less to live.	-	-
Iowa	NR	NR	NR	NR	-	-
Kansas	Yes	CN	No	Service intensity add on payment for end of life care is limited to 4 hours per day. Leave days are limited to 18 days per calendar year.	-	-
Kentucky	Yes	CN	No	No	-	-
Louisiana	Yes	CN	No	NR	-	-
Maine	Yes	CN	No	No	-	-
Maryland	Yes	CN	No	No	-	-
Massachusetts	Yes	CN	No	No	-	-
Michigan	Yes	CN	No	Medically necessary	-	-
Minnesota	Yes	CN	No	No	-	-
Mississippi	Yes	CN	No	Services are prior authorized for medical necessity to ensure appropriate utilization.	-	-
Missouri	Yes	CN	No	There are daily quantity limits on services.	-	-
Montana	Yes	CN	No	No	-	-
Nebraska	Yes	CN	No	No	-	-
Nevada	Yes	CN	Patient Liability	Prior authorization required	-	-
New Hampshire	NR	NR	NR	NR	-	-
New Jersey	Yes	CN	No	No	-	-
New Mexico	Yes	CN	No	No	-	-
New York	NR	NR	NR	NR	-	-
North Carolina	Yes	CN	No	NR	-	-
North Dakota	Yes	CN	No	No	-	-
Ohio	Yes	CN	No	Physician Certified as terminally ill	-	-
Oklahoma	Yes	CN	No	Only for adults in the ADvantage Waiver.	-	-
Oregon	Yes	CN	No	All coverage is based upon the prioritized list of health services. Services are PA and based upon an individual plan of care	-	-
Pennsylvania	Yes	CN	No	Respite care may not exceed a total of 5 days in a 60-day certification period.	-	-
Rhode Island	Yes	CN	No	No	-	-
South Carolina	NR	NR	NR	NR	-	-
South Dakota	Yes	CN	No	NR	-	-
Tennessee	Yes	CN	No	No	-	-
Texas	Yes	CN	No	There is no limitation of days, but there are the following utilization controls: Routine Home Care - the first 60 days of service; Continuous Home Care provided only during a period of crisis for up to five days; and Service Intensity Add-On -provided during the last seven days of life for care provided by a registered nurse or social worker. Requires recertification every six months.	-	-
Utah	Yes	CN	No	No	-	-
Vermont	Yes	CN	No	No	-	-
Virginia	Yes	CN	No	No	-	-
Washington	Yes	CN	No	No	-	-
West Virginia	Yes	CN	No	PA required for all certifications & re-certifications including: initial 90-day period, subsequent 90-day period, & an unlimited number of subsequent 60-day periods that will continue as long as the member lives unless he/she revokes hospice care or is discharged from hospice care	-	-
Wisconsin	Yes	CN	No	NR	-	-
Wyoming	Yes	CN	No	Hospice Benefit Election Form and physician certification of terminal illness required. Prior authorization is required for hospice clients receiving services in a nursing home.	-	-

2012

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 42 No - 14		Yes - 4 No - 38
Alabama	Yes	CN				Fee for service up to 85% of physician fee for same service
Alaska	Yes	CN				Fee for service at 85% of physician fee
American Samoa	No
Arizona	Yes	CN & MN				Fee for service
Arkansas	Yes	CN & MN				Fee for service at 80% of physician fee
California	Yes	CN & MN				Fee for service
Colorado	Yes	CN				Fee for service
Connecticut	No
Delaware	Yes	CN		Direct reimbursement limited to services provided without physician supervision		Fee for Service
District of Columbia	No
Florida	Yes	CN & MN	$2/day			Fee for service at 80% of physician fee
Georgia	Yes	CN & MN				Fee for service at 84.645% of CMS RBRVS rates for 2000
Guam	Yes	CN				Fee for service at 85% of physician fee on Medicare fee schedule
Hawaii	No
Idaho	Yes	CN				Fee for service at 85% of physician fee
Illinois	Yes	CN & MN				Fee for service at physician fee
Indiana	Yes	CN				Fee for service at 60% of physician fee
Iowa	Yes	CN & MN			Specified services including some pain management	Fee for service at 80% of physician fee if no medical direction by anesthesiologist or at 60% if medical direction given
Kansas	Yes	CN & MN				Fee for service
Kentucky	Yes	A, B & C - See state-specific FN				Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN				Fee for service
Maine	Yes	CN & MN			Specified procedures and services	Fee for service at 75% of physician fee
Maryland	Yes	CN & MN				Fee for service
Massachusetts	No
Michigan	Yes	CN & MN			Selected procedures	Fee for service using base units, time and level of supervision
Minnesota	Yes	A & B - See state-specific FN				Fee for service
Mississippi	Yes	CN				Fee for service at 90% of Medicare fee, 50% of physician fee for medically directed anesthesia
Missouri	Yes	CN	$.50/day	CRNAs cannot bill for critical care visits		Fee for service
Montana	Yes	A & B - See state-specific FN	$4/episode of treatment			Fee for service
Nebraska	Yes	CN & MN				Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	No
New Jersey	No
New Mexico	Yes	CN				Fee for service
New York	No
North Carolina	Yes	CN & MN			Surgeon must obtain for specified services	Fee for service at 90% of physician fee without medical direction and at 50% of physician fee with medical direction
North Dakota	Yes	CN & MN				Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN	$3/visit			Fee for service
Oregon	Yes	A & B - See state-specific FN		Services limited to funded conditions on the priority list	Specified surgical services	Fee for service, using a percentage of Medicare rates
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	Yes	CN				Fee for service, at 90% of anesthesiologist rate
South Dakota	Yes	CN				Fee for service
Tennessee	Yes	A, B & C - See state-specific FN				See state-specific FN
Texas	Yes	CN & MN				Fee for service at 92% of physician fee
Utah	Yes	A, B & C - See state-specific FN		C - limited to qualifying emergency conditions		Fee for service or capitated rate
Vermont	Yes	A & B - See state-specific FN				Fee for service
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN				Fee for service
West Virginia	Yes	A, B & C				Fee for service using American Society of Anesthesiologists base values
Wisconsin	Yes	CN & MN				Fee for service
Wyoming	Yes	CN				Fee for service

2010

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 40 No - 16		Yes - 3 No - 37
Alabama	Yes	CN				Fee for service at 85% of physician fee
Alaska	No
American Samoa	No
Arizona	Yes	CN & MN				Fee for service
Arkansas	Yes	CN & MN				Fee for service at 80% of physician fee
California	Yes	CN & MN				Fee for service
Colorado	Yes	CN				Fee for service
Connecticut	No
Delaware	Yes	CN		Direct reimbursement limited to services provided without physician supervision		Fee for Service
District of Columbia	No
Florida	Yes	CN & MN				Fee for service at 80% of physician fee
Georgia	Yes	CN & MN				Fee for service at 84.645% of CMS RBRVS rates for 2000
Guam	No
Hawaii	No
Idaho	Yes	CN				Fee for service at 85% of physician fee
Illinois	Yes	CN & MN				Fee for service at physician fee
Indiana	Yes	CN				Fee for service at 60% of physician fee
Iowa	Yes	CN & MN			Specified services including some pain management	Fee for service at 80% of physician fee if no medical direction by anesthesiologist or at 60% if medical direction given
Kansas	Yes	CN & MN				Fee for service
Kentucky	Yes	A, B & C - See state-specific FN				Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN				Fee for service
Maine	Yes	CN & MN			Specified procedures and services	Fee for service at 75% of physician fee
Maryland	Yes	CN & MN				Fee for service
Massachusetts	No
Michigan	Yes	CN & MN			Selected procedures	Fee for service using base units, time and level of supervision
Minnesota	Yes	A & B - See state-specific FN				Fee for service
Mississippi	Yes	CN				Fee for service at 90% of physician fee, 50% of physician fee for medically directed anesthesia
Missouri	Yes	CN	$.50/day	CRNAs cannot bill for critical care visits		Fee for service
Montana	Yes	A & B - See state-specific FN	$4/episode of treatment			Fee for service
Nebraska	Yes	CN & MN				Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	No
New Jersey	No
New Mexico	Yes	CN				Fee for service
New York	No
North Carolina	Yes	CN & MN			Surgeon must obtain for specified services	Fee for service at 90% of physician fee without medical direction and at 50% of physician fee with medical direction
North Dakota	Yes	CN & MN				Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN	$3/visit			Fee for service
Oregon	Yes	A & B - See state-specific FN		Services limited to funded conditions on the priority list	Specified surgical services	Fee for service, using a percentage of Medicare rates
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	Yes	CN				Fee for service, at 90% of anesthesiologist rate
South Dakota	Yes	CN				Fee for service
Tennessee	Yes	A & B - See state-specific FN				See state-specific FN
Texas	Yes	CN & MN				Fee for service at 92% of physician fee
Utah	Yes	A, B & C - See state-specific FN		C - limited to qualifying emergency conditions		Fee for service
Vermont	Yes	A & B - See state-specific FN				Fee for service
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN				Fee for service
West Virginia	Yes	A, B & C				Fee for service using American Society of Anesthesiologists base values
Wisconsin	Yes	CN & MN				Fee for service
Wyoming	Yes	CN				Fee for service

2008

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 40 No - 16		Yes - 4 No - 36
Alabama	Yes	CN				Fee for service at 85% of physician fee
Alaska	No
American Samoa	No
Arizona	Yes	CN & MN				Fee for service
Arkansas	Yes	CN & MN				Fee for service at 80% of physician fee
California	Yes	CN & MN				Fee for service
Colorado	Yes	CN				Fee for service
Connecticut	No
Delaware	Yes	CN		Direct reimbursement limited to services provided without physician supervision		Fee for Service
District of Columbia	No
Florida	Yes	CN & MN				Fee for service at 80% of physician fee
Georgia	Yes	CN & MN				Fee for service at 84.645% of CMS RBRVS rates for 2000
Guam	No
Hawaii	No
Idaho	Yes	CN				Fee for service at 85% of physician fee
Illinois	Yes	CN & MN				Fee for service at physician fee
Indiana	Yes	CN				Fee for service at 60% of physician fee
Iowa	Yes	CN & MN			Specified services including some pain management	Fee for service at 80% of physician fee if no medical direction by anesthesiologist or at 60% if medical direction given
Kansas	Yes	CN & MN				Fee for service
Kentucky	Yes	A, B & C - See state-specific FN				Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN				Fee for service
Maine	Yes	CN & MN			Specified procedures and services	Fee for service at 75% of physician fee
Maryland	Yes	CN & MN				Fee for service
Massachusetts	No
Michigan	Yes	CN & MN			Selected procedures	Fee for service using base units, time and level of supervision
Minnesota	Yes	A & B - See state-specific FN				Fee for service
Mississippi	Yes	CN	$3/visit			Fee for service at 90% of physician fee, 50% of physician fee for medically directed anesthesia
Missouri	Yes	CN	$.50/day			Fee for service
Montana	Yes	A & B - See state-specific FN	$4/episode of treatment			Fee for service
Nebraska	Yes	CN & MN				Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	No
New Jersey	No
New Mexico	Yes	CN				Fee for service
New York	No
North Carolina	Yes	CN & MN			Surgeon must obtain for specified services	Fee for service at 90% of physician fee without medical direction and at 50% of physician fee with medical direction
North Dakota	Yes	CN & MN				Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN	$1/service			Fee for service
Oregon	Yes	A & B - See state-specific FN				Fee for service
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	Yes	CN				Fee for service, at 90% of anesthesiologist rate
South Dakota	Yes	CN				Fee for service
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN				Fee for service at 92% of physician fee
Utah	Yes	A, B & C - See state-specific FN				Fee for service
Vermont	Yes	A & B - See state-specific FN				Fee for service
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN				Fee for service
West Virginia	Yes	A, B & C				Fee for service using ASA base values
Wisconsin	Yes	CN & MN				Fee for service
Wyoming	Yes	CN				Fee for service

2006

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 38 No - 18		Yes - 4 No - 34
Alabama	Yes	CN				Fee for service at 85% of physician fee
Alaska	No
American Samoa	No
Arizona	Yes	CN & MN				Fee for service
Arkansas	Yes	CN & MN				Fee for service at 80% of physician fee
California	Yes	CN & MN				Fee for service
Colorado	Yes	CN				Fee for service
Connecticut	No
Delaware	Yes	CN		Direct reimbursement limited to services provided without physician supervision		Fee for Service
District of Columbia	No
Florida	Yes	CN & MN				Fee for service at 80% of physician fee
Georgia	No
Guam	No
Hawaii	No
Idaho	Yes	CN				Fee for service at 85% of physician fee
Illinois	Yes	CN & MN				Fee for service at physician fee
Indiana	Yes	CN				Fee for service at 60% of physician fee
Iowa	Yes	CN & MN			Specified services including some pain management	Fee for service at 80% of physician fee if no medical direction by anesthesiologist or at 60% if medical direction given
Kansas	Yes	CN & MN				Fee for service
Kentucky	Yes	A, B & C - See state-specific FN				Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN				Fee for service
Maine	Yes	CN & MN			Specified procedures and services	Fee for service at 75% of physician fee
Maryland	Yes	CN & MN				Fee for service
Massachusetts	No
Michigan	Yes	CN & MN				Fee for service
Minnesota	Yes	A & B - See state-specific FN				Fee for service
Mississippi	Yes	CN	$3/visit			Fee for service at 90% of physician fee, 50% of physician fee for medically directed anesthesia
Missouri	Yes	CN	$.50/day			Fee for service
Montana	Yes	A & B - See state-specific FN	$4/episode of treatment			Fee for service, some services reimbursed at 90% of physician fee
Nebraska	Yes	CN & MN				Fee for service
Nevada	Yes	CN				Fee for service
New Hampshire	No
New Jersey	No
New Mexico	Yes	CN				Fee for service
New York	No
North Carolina	Yes	CN & MN			Surgeon must obtain for specified services	Fee for service at 90% of physician fee without medical direction and at 50% of physician fee with medical direction
North Dakota	Yes	CN & MN				Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN				Fee for service
Oklahoma	Yes	CN	$1/service			Fee for service
Oregon	Yes	A & B - See state-specific FN				Fee for service
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	Yes	CN				Fee for service, at 50% of physician fee
South Dakota	Yes	CN				Fee for service
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN				Fee for service at 92% of physician fee
Utah	Yes	A, B & C - See state-specific FN				Fee for service
Vermont	No
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN				Fee for service
West Virginia	Yes	CN & MN				Fee for service
Wisconsin	Yes	CN & MN				Fee for service
Wyoming	Yes	CN				Fee for service

2004

Location	Benefit Covered	Coverage Code	Copayment Required?	Prior Approval Required	Reimbursement Methodology
United States	Yes - 37 No - 19		Yes - 3 No - 34
Alabama	Yes	CN			Fee for service at 85% of physician fee
Alaska	No
American Samoa	No
Arizona	Yes	CN & MN			Fee for service
Arkansas	Yes	CN & MN			Fee for service at 80% of physician fee
California	Yes	CN & MN			Fee for service
Colorado	Yes	CN			Fee for service
Connecticut	No
Delaware	No
District of Columbia	No
Florida	Yes	CN & MN			Fee for service at 80% of physician fee
Georgia	No
Guam	No
Hawaii	No
Idaho	Yes	CN			Fee for service at 85% of physician fee
Illinois	Yes	CN & MN			Fee for service at 70% of physician fee
Indiana	Yes	CN			Fee for service at 60% of physician fee
Iowa	Yes	CN & MN		Specified services including some pain management	Fee for service at 80% of physician fee if no medical direction by anesthesiologist or at 60% if medical direction given
Kansas	Yes	CN & MN			Fee for service
Kentucky	Yes	CN & MN			Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN			Fee for service
Maine	Yes	CN & MN		Specified procedures and services	Fee for service at 75% of physician fee
Maryland	Yes	CN & MN			Fee for service
Massachusetts	No
Michigan	Yes	CN & MN			Fee for service
Minnesota	Yes	A & B - See state-specific FN			Fee for service
Mississippi	Yes	CN	$3/visit		Fee for service at 90% of physician fee, 50% of physician fee for medically directed anesthesia
Missouri	Yes	CN			Fee for service
Montana	Yes	A & B - See state-specific FN	$4/episode of treatment		Fee for service, some services reimbursed at 90% of physician fee
Nebraska	Yes	CN & MN			Fee for service
Nevada	Yes	CN			Fee for service
New Hampshire	No
New Jersey	No
New Mexico	Yes	CN			Fee for service
New York	No
North Carolina	Yes	CN & MN		Surgeon must obtain for specified services	Fee for service at 90% of physician fee without medical direction and at 50% of physician fee with medical direction
North Dakota	Yes	CN & MN			Fee for service at 75% of physician fee
Northern Mariana Islands	No
Ohio	Yes	CN			Fee for service
Oklahoma	Yes	CN	$1/service		Fee for service
Oregon	Yes	A & B - See state-specific FN			Fee for service
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	Yes	CN			Fee for service, at 50% of physician fee
South Dakota	Yes	CN			Fee for service
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Fee for service at 85% of physician fee
Utah	Yes	A, B & C - See state-specific FN			Fee for service
Vermont	No
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN			Fee for service
West Virginia	Yes	CN & MN			Fee for service
Wisconsin	Yes	CN & MN			Fee for service
Wyoming	Yes	CN			Fee for service

2003

Location	Benefit Covered	Coverage Code	Copayment Required?	Prior Approval Required	Reimbursement Methodology
United States	Yes - 35 No - 21		Yes - 3 No - 32
Alabama	Yes	CN			Fee for service
Alaska	No
American Samoa	No
Arizona	Yes	CN & MN			Fee for service
Arkansas	Yes	CN & MN			Fee for service at 80% of physician fee
California	Yes	CN & MN			Fee for service
Colorado	Yes	CN			Fee for service
Connecticut	No
Delaware	No
District of Columbia	No
Florida	Yes	CN & MN			Fee for service at 80% of physician fee
Georgia	No
Guam	No
Hawaii	No
Idaho	Yes	CN			Fee for service at 85% of physician fee
Illinois	Yes	CN & MN			Fee for service at 70% of physician fee
Indiana	Yes	CN			Fee for service at 60% of physician fee
Iowa	Yes	CN & MN		Specified services including some pain management	Fee for service at 80% of physician fee if no medical direction by anesthesiologist or at 60% if medical direction given
Kansas	Yes	CN & MN			Fee for service
Kentucky	Yes	CN & MN			Fee for service at 75% of physician fee
Louisiana	Yes	CN & MN			Fee for service
Maine	Yes	CN & MN		Specified procedures and services	Fee for service at 75% of physician fee
Maryland	Yes	CN & MN			Fee for service
Massachusetts	No
Michigan	Yes	CN & MN			Fee for service
Minnesota	Yes	A & B - See state-specific FN			Fee for service
Mississippi	Yes	CN	$3/visit		Fee for service at 90% of physician fee, 50% of physician fee for medically directed anesthesia
Missouri	No
Montana	Yes	CN & MN	$4/episode of treatment		Fee for service, some services reimbursed at 90% of physician fee
Nebraska	Yes	CN & MN			Fee for service
Nevada	Yes	CN			Fee for service
New Hampshire	No
New Jersey	No
New Mexico	Yes	CN			Fee for service
New York	No
North Carolina	Yes	CN & MN		Surgeon must obtain for specified services	Fee for service at 90% of physician fee without medical direction and at 50% of physician fee with medical direction
North Dakota	No
Northern Mariana Islands	No
Ohio	Yes	CN			Fee for service
Oklahoma	Yes	CN & MN	$1/service		Fee for service
Oregon	Yes	CN & MN			Fee for service
Pennsylvania	No
Puerto Rico	No
Rhode Island	No
South Carolina	Yes	CN			Fee for service, at 50% of physician fee
South Dakota	Yes	CN			Fee for service
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Fee for service at 85% of physician fee
Utah	Yes	A, B & C - See state-specific FN			Fee for service
Vermont	No
U.S. Virgin Islands	No
Virginia	No
Washington	Yes	CN & MN			Fee for service
West Virginia	Yes	CN & MN			Fee for service
Wisconsin	Yes	CN & MN			Fee for service
Wyoming	Yes	CN			Fee for service

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Medicaid Benefits: Hospice Care

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Medicaid Benefits: Hospice Care

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