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 or the
designated hospice's care:
(1) Discharge from
the designated hospice's care should occur when the individual:
(a) Dies;
(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
designated hospice provider's service
area;
(e) Enters a facility where
the designated hospice has no access
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 (E) 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
should
notify the Ohio department of medicaid (ODM) through the
ODM provider web portal
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 should 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 should be retained by the hospice for its records,
with a copy provided to the individual. As a reason for discharge, a hospice
provider cannot 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) should end and the individual
should
be discharged from the hospice benefit entirely, making him or her no longer
eligible to receive medicaid hospice services.
(B) The individual
has the right 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 should:
(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
should
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 will 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) The individual
discharged from hospice care during the initial ninety-day period, who
re-elects the hospice benefit, should be enrolled in the second ninety-day benefit
period; or
(D) 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, should be
enrolled in a subsequent sixty-day benefit period.
(E) 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 should 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.
(F) The individual who
has elected the hospice benefit and decided to revoke, terminate, or transfer
his or her hospice benefit should 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 will ensure the
medicaid hospice benefit is revoked by the individual at the same
time.
(G) Any denial or
termination of hospice care which is the result of an Ohio department of
medicaid (ODM) decision will be subject to the notice and hearing rights
contained in Chapters 5101:6-1 to 5101:6-9 of the Administrative
Code.
