A. The hospice
benefit must be used simultaneously under Medicare and Medicaid with Medicare
providing primary coverage for dual eligible beneficiaries.
B. The Division of Medicaid requires the
hospice provider to submit the Notice of Hospice Election or Discharge for Dual
Eligible Beneficiaries (Form DOM 1166C) to the Division of Medicaid's
Utilization Management/Quality Improvement Organization (UM/QIO) within five
(5) calendar days of the beneficiary's hospice election or discharge date.
1. If the hospice provider fails to submit
Form DOM 1166C to the UM/QIO within five (5) calendar days of the election
period, the effective date will be the date when the completed Form DOM 1166C
is received.
a) The Division of Medicaid will
not reimburse the hospice or nursing facility providers for days prior to the
effective date of the election statement.
b) The hospice and/or nursing facility cannot
seek payment from the beneficiary.
2. The UM/QIO will issue a prior
authorization number once Form DOM 1166C is received to be notated on the claim
by the hospice provider for nursing facility room and board
reimbursement.
3. If the
beneficiary elects the hospice benefit in a home setting, the UM/QIO will issue
a prior authorization number once Form DOM 1166C is received.
C. The Division of Medicaid may
waive the consequences of failure to submit timely documentation for
exceptional circumstances.
1. Exceptions to
notice within five (5) calendar days:
a)
Fire,
b) Floods,
c) Embargoes,
d) War, acts of war, insurrections,
riots,
e) Strikes, lockouts or
other labor disturbances,
f) Or
acts of God.
2. A
provider so affected shall use reasonable commercial efforts to avoid or remove
such causes of nonperformance, and shall provide proper notice hereunder
immediately whenever such causes are removed. Changes to the scope of available
services or reimbursement methodology for the provision of certain services
through legislative or regulatory action shall not constitute an unforeseeable
circumstance within the meaning of this section.
42 C.F.R.
§ 418.24; Miss. Code Ann. §
43-13-121.
