Current through Register Vol. 56, No. 18, September 16, 2024
(a) There are two 90-day benefit periods and an unlimited number of subsequent 60-day periods. The benefit periods shall be recorded on a Hospice Benefits Statement, FD-379 (Form #2 in the Appendix, incorporated herein by reference) and filed in the beneficiary's medical record.
(b) Contents of the Election of Hospice Benefits Statement, FD-378 (Appendix Form #1) shall include the following:
1. The identification of the particular hospice that will provide the care to the applicant;
2. The applicant's or his or her representative's acknowledgment, that he or she has been given a full understanding of hospice services;
3. The applicant's or his or her representative's acknowledgment that he or she understands that the regular Medicaid/NJ FamilyCare FFS services other than hospice services are waived by the signing of the Election of Hospice Benefits Statement, FD-378 and/or the Representative Statement for the Election of Hospice Benefits, FD-380 (Form #3 in the Appendix, incorporated herein by reference), unless the services are prior authorized;
4. The effective date of the election statement; and
5. The signature of the applicant or the applicant's representative.
(c) If the applicant or his or her representative files an Election of Hospice Benefits Statement, FD-378, the hospice applicant is eligible for two 90-day benefit periods of hospice services totaling 180 days and an unlimited number of subsequent 60-day periods with the approval of the hospice provider.
1. A hospice beneficiary shall designate an effective date for the beginning of hospice services which shall not be earlier than the date the election is made.
(d) Revocation of election of hospice services shall be as follows:
1. The beneficiary may choose at any time to institute a "break" (a time period when care other than hospice care is given) between benefit periods or by a revocation of hospice services.
2. The Election of Hospice Benefits Statement, FD-378 shall be considered to be valid through subsequent benefit periods if there is no "break" in care.
3. A new Election of Hospice Benefits Statement, FD-378 is required to be filed following a break or revocation of hospice service.
i. The beneficiary or his or her representative shall file a signed statement with the hospice provider that indicates the beneficiary revokes the election for Medicaid/NJ FamilyCare FFS coverage of hospice services for the remainder of the election period with the date that the revocation is to be effective.
ii. When revoked, the beneficiary forfeits hospice services for any remaining days in the benefit period. A beneficiary may not receive hospice services later than the effective date that the revocation is signed.
iii. The hospice shall immediately notify the agency that determined hospice eligibility (either CWA, DCP&P, or the MACC) of the revocation of hospice, verbally if possible, and also by filling out and submitting the Hospice Eligibility Form, FD-383 (5/01) to the eligibility source ( CWA, MACC or DCP&P, as applicable) so that the beneficiary's hospice eligibility may be terminated. The hospice shall also fill out the Termination of Hospice Benefits, FD-382 (Form #5 in the Appendix, incorporated herein by reference) and retain this form in the beneficiary's medical record.
(e) Entitlement to all other Medicaid/NJ FamilyCare FFS services may be restored if the beneficiary continues to be Medicaid/NJ FamilyCare FFS eligible, under the following circumstances:
1. When the 180 days of hospice entitlement has expired, and the beneficiary does not choose the unlimited benefit periods; or
2. When the beneficiary revokes hospice services.
(f) When a hospice beneficiary residing in a nursing facility revokes the hospice benefits and returns to the status of a patient of the NF, the hospice shall proceed as follows:
1. The Hospice Eligibility Form, FD-383 shall be completed and submitted to the eligibility determining agency after the beneficiary has signed the Revocation of Hospice Benefits, FD-381 form indicating he or she has revoked the Medicaid/NJ FamilyCare FFS hospice benefit.
i. For SSI beneficiaries, the hospice shall submit the FD-383 to the medical assistance customer center;
ii. For Medicaid Only and New Jersey Care . . . Special Program beneficiaries, the hospice shall submit the FD-383 to the county welfare agency of the beneficiary's residence; and
iii. For children in foster care, the hospice shall submit the FD-383 to the Division of Child Protection and Permanency district office.
2. The nursing facility shall conform to the nursing facility rules and regulations in N.J.A.C. 10:63, Long Term Care Services, for admission and placement and shall treat this beneficiary in the same manner as other persons being admitted or placed in the NF.
