Qualifying conditions must be met. Any additional services and all private duty require prior authorization. Medical supplies and equipment are covered according to Medicare guidelines based on diagnosis and criteria. IV medications administered at home are generally not covered except for a few specific agents that are given as prolonged infusions. Disposable, consumable, expandable or nondurable medically necessary supplies are covered if necessary to carry out the plan of care.
Prior authorization is required for certain items.
A co-payment may be required to be paid by the recipient based on the established Medicaid guideline fee schedule. Hospice is appropriate for clients who are no longer receiving active treatment for a life limiting illness. A physician must verify that the client has a life expectancy of no more than six months. The Nurse Case Manager makes contact with physician for approval and follows up with a written physician order. Inc. Same as Medicare, and additional Medicaid stipulations.