Ala. Admin. Code r. 560-X-51-.12

Current through Register Vol. 42, No. 12, September 30, 2024

Section 560-X-51-.12 - Payment Acceptance

(1) Payment made by the Medicaid program for hospice care services shall be considered payment in full.

(2) The patient or responsible party shall not be billed in full or in part for any service reimbursed under any service component of the Medicaid Hospice Care Program. Services that are not considered hospice care and non-covered Medicaid services may be billed to the individual.

(3) Co-payments may not be imposed with respect to hospice service rendered to Medicaid recipients.

(4) No person or entity, except a third party resource, shall be billed, in part or in full, for Medicaid covered services.

(5) For dually eligible recipients for whom Medicare is the primary payer for hospice services, Medicaid may be billed for coinsurance amounts for:

(a) Drugs and biologicals furnished by the hospice while the recipient is not an inpatient at 5% of the cost of the drug or biological not to exceed $5.00 per prescription.

(b) Inpatient respite care equal to 5% of the payment made by CMS for a respite care day.

Author: Pricilla Miles, Associate Director, LTC Program Management Unit

Ala. Admin. Code r. 560-X-51-.12

Emergency rule effective October 1, 1990. Permanent Rule effective February 13, 1991. Amended: Filed August 6, 1993; effective September 10, 1993. Amended: Filed June 11, 2003; effective July 16, 2003.

Statutory Authority: Title XIX, Social Security Act; 42 C.F.R. §§418.400, 418.402; State Medicaid Manual; State Plan.