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 should report the necessary
enrollment information to the Ohio department of medicaid using the
ODM provider web portal 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
through
T2046, including:
(a) All individuals with FFS
claims for routine home care, code T2042, 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
should
adjust a FFS claim for hospice services other than the services specified in
paragraph (A)(2)(a) of this rule.
(B) The designated hospice
should
ensure the following information is entered into the ODM provider web
portal 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
should
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) should be
entered in the
ODM provider web portal 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 (LTCF) 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,
should be attached to the hospice
enrollment, 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 should be
submitted to ODM only through the system in accordance with the requirements of
the ODM
provider web portal.
