Current through Register Vol. 35, No. 18, September 24, 2024
To be eligible for hospice care, a physician must provide a
written certification that the recipient has a terminal illness. Recipients
must elect to receive hospice care for the duration of the election
period.
A. Certification of terminal
illness: The hospice must obtain a written certification statement signed by
the hospice medical director, physician member of the hospice interdisciplinary
team or recipient's attending physician that the recipient is terminally ill.
The physician must sign the written certification within seven calendar days of
the date services are initiated. Certification statements must include
information that is based on the recipient's medical prognosis, and the life
expectancy is six months or less if the terminal illness runs its typical
course.
(1) If a recipient receives hospice
benefits beyond 210 days, the hospice must obtain a written recertification
statement from the hospice medical director or the physician member of the
hospice interdisciplinary group before the 210-day period expires.
(2) Hospice benefits furnished beyond the
210-day period may be subject to medical review.
B. Election of hospice care: Recipients who
are eligible for hospice care must elect to receive hospice services.
Recipients or their legal representatives elect hospice services by filing an
election statement with a particular hospice designee.
(1) For the duration of the election,
recipients who elect hospice care, waive their right to medicaid payment for
the following services:
(a) services related
to treatment of the terminal condition or related condition for which hospice
care was elected; and
(b) services
equivalent to hospice care, such as home health services, and private duty
nursing services under enhanced early and periodic screening, diagnosis and
treatment (EPSDT).
(2)
Recipients who are receiving home and community based waiver services or other
in-home services based on a plan of care must have the plan of care coordinated
with the hospice provider and adjusted as necessary to avoid duplicative or
unnecessary services.
(3) Hospice
coverage continues for 210-day time periods, as long as recipients remain in
hospice care and do not cancel the election.
(4) Recipients or their representatives can
designate an effective date for the election. The effective date begins with
the first or any subsequent day of hospice services.
C. Election statement: The election statement
must include the following elements:
(1)
designation of the hospice that will provide care;
(2) designation of the recipient's attending
physician;
(3) acknowledgement that
the recipients or representatives has been given a full understanding of the
palliative rather than curative nature of hospice care;
(4) effective date of the election;
and
(5) the recipient's or the
representative's signature.
D. Revocation of hospice care services:
(1) A recipient or representative can cancel
the election of hospice care at any time by filing a statement with MAD or its
designee. The statement must include the following information:
(a) recipient is revoking their election for
medicaid coverage of hospice care;
(b) effective date of the revocation, which
is not earlier than the actual date of the revocation; and
(c) the recipient's or the representative's
signature.
(2) Upon
revocation of the election of hospice services, recipients are no longer
covered for medicaid hospice services.
(3) Recipients can elect to receive hospice
care services again at any time. The same process for approval of services must
be followed when the second election occurs. A new plan of care, certification
statement, and election statement must be submitted to MAD or its
designee.
E. Change of
designated hospice:
(1) Recipients or their
representatives can change designated hospice providers by filing statements
with MAD or its designee. A statement must contain the following information:
(a) name of the hospice the recipient is
leaving;
(b) name of the hospice
the recipient is entering; and
(c)
effective date of the change.
(2) A change in ownership or name of a
hospice is not considered a change in the recipient's designated
hospice.
