Current through all regulations passed and filed through September 16, 2024
This rule sets forth the requirements
for discharging an individual from the designated hospice's care and/or the
hospice benefit.
(A)
Discharge refers to the end the hospice benefit and/or
the designated hospice's care:
(1)
Discharge from the designated hospice's care shall
occur when the individual:
(a)
Dies/expires;
(b)
No longer meets
the hospice enrollment or eligibility criteria;
(c)
No longer is
terminally ill, e.g., physician discharges or does not recertify the
individual;
(d)
Moves out of the service area;
(e)
Enters a facility
where the designated hospice has no access and/or cannot enter to provide
care;
(f)
Revokes the hospice benefit in accordance with
paragraph (B) of this rule;
(g)
Transfers to
another hospice in accordance with paragraph (D) of this rule;
or
(h)
Is discharged for cause, such as compromising the
safety of self or the safety of the hospice staff.
(2)
The hospice
provider must notify the Ohio department of medicaid (ODM) through the medicaid
information technology system (MITS) or its designee of the individual's
discharge from the designated hospice's care so that the designated hospice's
services and billings coincide with the date of the individual's discharge
and/or so that hospice services may continue with the new hospice when
applicable, e.g., following a transfer.
(3)
Except for the
reason cited in paragraph (A)(1)(a) of this rule, the designated hospice shall
complete a written summary statement which clearly states the reason(s) for the
individual's discharge from the designated hospice's care. The original
statement of discharge shall be retained by the hospice for its records, with a
copy provided to the individual. As a reason for discharge, a hospice provider
may not automatically or routinely discharge an individual at its "discretion"
or request or demand that the individual revoke his or her
election.
(4)
With the exception of paragraph (A)(1)(g) of this rule,
when an individual is discharged from a designated hospice's care, the current
election period (as defined in rule
5160-56-01 of the Administrative
Code) shall end and the individual shall be discharged from the hospice benefit
entirely, making him or her no longer eligible to receive medicaid hospice
services.
(B)
The designated provider shall respect the right of the
individual to revoke the election of the hospice benefit at any time during any
given election period.
(1)
Upon notice of the individual's intent to revoke, the
designated hospice shall:
(a)
Obtain a written statement, signed and dated by the
individual, which states that the election of hospice care has been revoked by
the individual for the remainder of the applicable benefit period. The
designated hospice shall not accept a verbal revocation of the hospice
benefit;
(b)
Discharge the individual from hospice care, such that
hospice coverage for the remaining days in that election period is forfeited
and medicaid coverage of the benefits waived when hospice care was elected may
resume; and
(c)
Provide the individual with a copy of the written
revocation statement and maintain the original for its record.
(2)
An
individual shall be permitted to re-elect the medicaid hospice benefit at any
time after revocation pursuant to paragraph (C) of this rule, provided the
individual meets all hospice eligibility requirements.
(C)
If the
individual remains eligible for hospice, a designated hospice may enroll an
individual at any time after the re-election.
(1)
The individual
discharged from hospice care during the initial ninety-day period, who
re-elects the hospice benefit, shall be enrolled in the second ninety-day
benefit period; or
(2)
The individual who revoked the hospice benefit or who
was discharged from hospice care during the second ninety-day benefit period,
or any subsequent sixty-day benefit period, who re-elects the hospice benefit,
shall be enrolled in a subsequent sixty-day benefit period.
(D)
The
following requirements apply when an individual is discharged from the
designated hospice's care due to individual's transfer to another
hospice:
(1)
The individual may change the designation of the hospice
from which care is received once during each benefit period. The change of the
designated hospice is not considered a revocation of the election from the
period in which it is made.
(2)
To change the
designated hospice, the individual must file, with the hospice from which the
individual has received care and the newly designated hospice, a signed
statement which includes the following information:
(a)
The name of the
hospice from which the individual has received care;
(b)
The name of the
hospice from which the individual plans to receive care; and
(c)
The date the
change is to be effective.
(3)
When an
individual transfers from one hospice to another, his or her medicaid hospice
benefit shall continue without interruption of care.
(E)
The individual
who has elected the hospice benefit and decided to revoke, terminate, or
transfer his or her hospice benefit must do so on the same effective date for
both the third-party covered or medicare hospice benefit and the medicaid
hospice benefit. When the dual eligible individual revokes his or her medicare
hospice benefit, the provider shall ensure the medicaid hospice benefit is
revoked by the individual at the same time.
(F)
Any denial or
termination of hospice care which is the result of an Ohio department of
medicaid (ODM) decision shall be subject to the notice and hearing rights
contained in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code.
Replaces: 5160-56-03
