Current through all regulations passed and filed through September 16, 2024
This rule sets forth the requirement
for recording the hospice provider span for individuals receiving medicaid
hospice care in accordance with Chapter 5160-56 of the Administrative Code,
including individuals who may be covered by third-party insurance, such as
medicare, for which the hospice seeks reimbursement.
(A)
The designated
hospice shall report the required enrollment information to the Ohio department
of medicaid using the medicaid information technology system (MITS) for the
following:
(1)
Individuals in fee-for-service (FFS) medicaid hospice under
the designated hospice's care on the effective date of this rule;
and
(2)
Individuals in which the hospice seeks to file an
original or adjusted claim to ODM for medicaid hospice services rendered under
codes T2042 and T2046, including:
(a)
All individuals with FFS claims for routine home care,
code T2042, for the dates of service on or after January 1, 2016, whether or
not the claim has previously been submitted and paid.
(b)
Individuals in
the care of hospice prior to the effective date of this rule, if the provider
is submitting an original FFS claim for hospice services other than the
services specified in paragraph (A)(2)(a) of this rule.
(c)
Individuals in
the care of hospice prior to the effective date of this rule, if the provider
is submitting an adjusted FFS claim or if ODM must adjust a FFS claim for
hospice services other than the services specified in paragraph (A)(2)(a) of
this rule.
(B)
The designated
hospice shall ensure the following information is entered into MITS prior to
submitting a claim for reimbursement:
(1)
The individual's
recipient identification number (also referred to as the medicaid billing
number) as shown on the individual's medicaid card;
(2)
The date the
individual elected hospice;
(3)
The begin date
and end date of every benefit period recognized under paragraph (D) of rule
5160-56-02 of the Administrative
Code. For each benefit period, the designated hospice shall identify the
benefit period as either the initial one time ninety-day period, the subsequent
one time ninety-day period, or one of the subsequent unlimited sixty-day
periods as applicable;
(4)
The national provider identifier for the medical doctor
who serves on the hospice interdisciplinary group (IDG) for each benefit
period;
(5)
The national provider identifier for the attending
physician or the advanced practice registered nurse for each benefit
period;
(6)
The oral certification date(s), if
applicable;
(7)
The written physician certification
date(s);
(8)
The hospice terminal illness diagnosis code(s);
(a)
At least one but
not more than three terminal diagnosis codes for the
individual;
(b)
The effective dates (begin and ending date) that apply
to the terminal diagnosis code(s) shall be entered in MITS by the designated
hospice;
(9)
The county (or counties if more than one) where hospice
services were or will be provided during the benefit period;
(10)
The national
provider identifier of the long term care facility (LTFC) and the corresponding
effective date and end date, if the individual resides in a LTCF and provider
will be billing for hospice room and board services;
(11)
Supporting
documentation, as required to be attached to the claim, including:
(a)
Copy of the
current certification of the terminal illness;
(b)
Copy of the
individual's election statement;
(12)
The date of
death, when applicable; and
(13)
Any updates or
changes to be made to the benefit period as a result of a discharge pursuant to
rule 5160-56-03 of the Administrative
Code.
(C)
The information specified in paragraph (B) of this rule
shall be submitted to ODM only through the system in accordance with the
requirements of the MITS system.
Replaces: 5160-56- 03.3
