Hospice Grid - Contact the Husky Health Program and Charter Oak ...

HUSKY Health Benefits and Prior Authorization Requirements Grid*HospiceEffective: January 1, 2014Member Services: 800-859-9889Authorizations: 800-440-5071 Option #2Authorization Fax: 203-265-3994Benefit HUSKY A, HUSKY C (ABD) HUSKY B HUSKY D (LIA)HospiceProvided tomembers whoare diagnosed ashaving a terminalillness with a lifeexpectancy of sixmonths or lessPrior Authorization Required For:Inpatient days beyond the5 th day (RCC 656)Prior Authorization Required For:Inpatient days beyond the5 th day (RCC 656)Covered 100% - Requirescompleted Hospice Election FormCovered care includes nursing care,physical therapy, speech therapy,and occupational therapy, medicalsocial services. Home health aidesand homemakers, medical supplies,drugs, appliances, DME, physicianservices, short term inpatient care,including respite care and care forpain control and acute and chronicsymptoms management and otherbenefits when ordered by aphysician.Covered 100% - Requirescompleted Hospice Election FormCovered care includes nursing care,physical therapy, speech therapy,and occupational therapy, medicalsocial services. Home health aidesand homemakers, medical supplies,drugs, appliances, DME, physicianservices, short term inpatient care,including respite care and care forpain control and acute and chronicsymptoms management and otherbenefits when ordered by aphysician.Prior Authorization Required For:Inpatient days beyond the5 th day (RCC 656)Covered 100% - Requirescompleted Hospice Election FormCovered care includes nursing care,physical therapy, speech therapy,and occupational therapy, medicalsocial services. Home health aidesand homemakers, medical supplies,drugs, appliances, DME, physicianservices, short term inpatient care,including respite care and care forpain control and acute and chronicsymptoms management and otherbenefits when ordered by aphysician.Coverage includes both inpatientand outpatient hospice.*Not a Legal Document. Contents provide a generaldescription of HUSKY Health Benefits. Coveragesubject to change per Department of Social Services.Coverage includes both inpatientand outpatient hospice.1Coverage includes both inpatientand outpatient hospice.Last Update: 1/1/14BGHHE0010-0114

HUSKY Health Benefits and Prior Authorization Requirements Grid*HospiceEffective: January 1, 2014Member Services: 800-859-9889Authorizations: 800-440-5071 Option #2Authorization Fax: 203-265-3994Benefit HUSKY A, HUSKY C (ABD) HUSKY B HUSKY D (LIA)Members under age 21 do notneed to waive their rights fortreatment of the terminalcondition when electing hospice.Members do not need to waivetheir rights for treatment of theterminal condition when electinghospiceMembers under age 21 do notneed to waive their rights fortreatment of the terminalcondition when electing hospice.Out of NetworkServicesTranslationservices viaPhone:Language lineNon-CoveredProviders must be an enrolledCMAP provider to be reimbursedfor services.Non-CoveredProviders must be an enrolledCMAP provider to be reimbursed forservices.Non-CoveredProviders must be an enrolledCMAP provider to be reimbursedfor services.1-800-874-9426 1-800-874-9426 1-800-874-9426*Not a Legal Document. Contents provide a generaldescription of HUSKY Health Benefits. Coveragesubject to change per Department of Social Services.2Last Update: 1/1/14BGHHE0010-0114