Current through all regulations passed and filed through September 16, 2024
(A)
To be covered under Ohio medicaid, the designated hospice
will
ensure the following criteria are met prior to furnishing hospice care:
(1) The designated hospice has a
certification of the terminal illness on behalf of the individual, obtained in
accordance with 42 C.F.R.
418.22 (October 1, 2023);
(2) A hospice election statement, completed
by the individual, has been obtained by the designated hospice pursuant to
paragraphs (B) and (C) of this rule;
(3) The individual has a hospice plan of care
initiated, pursuant to paragraph (F) of this rule.
(B) The designated
hospice will ensure an individual eligible for both medicare
and medicaid hospice elects the hospice benefit under both programs. Hospice
services furnished to individuals who are dual eligible
should
be billed to medicare first.
(C) If the individual
has or later obtains third-party coverage of hospice, the individual
should
elect the third-party coverage of hospice to cover the same days the medicaid
hospice benefit covers in order to ensure medicaid is the secondary payor. If
the individual revokes his or her third-party coverage of hospice, the medicaid
hospice benefit should be revoked at the same time.
(D) If
the individual is a participant in the program of all-inclusive care for the
elderly (PACE), the individual should access hospice services through the PACE site's
network of providers.
(E) If the individual
is enrolled in a medicaid managed care organization
(MCO)
, the individual
should
access hospice services through the MCO's network of
providers.
(F) If the individual
is enrolled in a home and community based services (HCBS) waiver, the
designated hospice will assist the individual in coordinating concurrent
care and waiver services in accordance with rule
5160-56-04 of the Administrative
Code.
(G) At the time hospice
is elected, the designated hospice will:
(1) Assist the
individual with the election process; and
(2) Provide the individual with the following
materials and written information:
(a) A copy
of the agency's grievance procedures;
(b) Information regarding advance directives
in accordance with Chapter 2133. of the Revised Code; and
(c) Any policies the hospice has regarding
the implementation of advance directives, including ensuring the individual's
right to formulate an advance directive, and the right to request a "do not
resuscitate" order. The hospice should maintain the individual's advance directive in
an accessible part of the individual's current hospice record and include a
notation in the individual's plan of care.
(H)
The designated hospice should maintain a record of the election statement
completed by the individual.
(1) The election
statement should be in writing and a notice of the election
filed by the designated hospice in accordance with
42 C.F.R.
418.24 (October 1, 2023). The
medicaid election statement may be combined with the medicare election
statement or on a separate form, provided it is clear the form denotes medicaid
hospice has been elected.
(2) The
election statement should contain the following:
(a) Documentation that the individual elected
the medicaid hospice benefit;
(b)
The identity of the designated hospice responsible for providing hospice care
to the individual;
(c) The
individual's acknowledgment that he or she has been given a full explanation of
the palliative rather than curative nature of hospice care as it relates to the
individual's terminal illness and the provisions and limitations of services as
specified in this chapter;
(d)
Acknowledgment that the individual understands that certain medicaid services
are waived by the election, except when the individual is under age
twenty-one;
(e) The identification
of the individual's attending physician (if any) with an acknowledgment that
the identified attending physician was the individual's own choice;
(f) The individual's acknowledgment that the
attending physician was the individual's choice;
(g) The effective date of the election which
may be the first day of hospice care or a later date, but
should
not be earlier than the date of
the election statement;
(h) The
individual's signature; and
(i) The
date the election statement was signed.
(3) A copy of the completed election
statement shall be scanned and uploaded to the ODM provider web portal pursuant to rule
5160-56-03.3 of the
Administrative Code. The original form as completed, should remain on
file with the designated hospice.
(4) The election statement
should
remain in effect as long as the individual continues to meet all eligibility
requirements of this rule.
(I) While a hospice
election is in effect, the designated hospice should commence
hospice care to the individual, beginning with enrolling the individual in the
appropriate benefit period as defined in rule
5160-56-01 of the Administrative
Code and pursuant to the remainder of this rule.
(1) The initial benefit period
should
commence with hospice care on or after the date of election and end on the
ninetieth day, unless a discharge pursuant to rule
5160-56-03 of the Administrative
Code disrupts hospice care.
(2) If
at the end of the initial ninety day period, the individual is recertified as
terminally ill, the designated hospice will ensure the
individual is enrolled in the second subsequent ninety-day benefit period,
continuing hospice services uninterrupted until the end the second
ninety-period, to the one-hundred eightieth day, unless a discharge pursuant to
rule 5160-56-03 of the Administrative
Code disrupts hospice care.
(3) If
at the end of the subsequent ninety day period, the individual is recertified
as terminally ill, the designated hospice will ensure the
individual is enrolled in a subsequent sixty day benefit period, and
will
continue hospice services uninterrupted for increments of sixty additional days
as recertifications occur, unless a discharge pursuant to rule
5160-56-03 of the Administrative
Code disrupts hospice care.
(J) For the duration of
the election of hospice care, the individual should waive
medicaid services if the services:
(1) Are
provided by a hospice other than the hospice designated by the individual,
unless provided under arrangement made by the designated hospice;
(2) Are related to the curative treatment of
the terminal condition for which hospice care was elected or a related
condition, except for the individual under age twenty-one; or
(3) Are equivalent to hospice care such as
non-waiver services provided through home health and private duty nursing
services.
(K) The designated
hospice should follow the requirements as prescribed in this
rule for an individual previously discharged from hospice, who has subsequently
re-elected hospice care in accordance with paragraphs (C) and
(D) of rule
5160-56-03 of the Administrative
Code.
