Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-56 - Medicaid Hospice Program
Section 5160-56-04 - Hospice services: provider requirements
Current through all regulations passed and filed through September 16, 2024
This rule sets forth the responsibilities, including the conditions of participation for a hospice engaged in the provision of medicaid hospice services. To be eligible to provide and to request reimbursement for hospice services, a designated hospice should:
(A) Meet the medicare guidelines in accordance with 42 C.F.R. part 418 (October 1, 2023).
(B) Be authorized to provide services under Ohio law in accordance with Chapter 3712. of the Revised Code by the Ohio department of health.
(C) Ensure that all hospice employees, volunteers, and contracted staff who provide direct services to hospice individuals are trained, licensed, certified, or registered in accordance with applicable federal and state law. ODM will allow hospices to utilize pseudo-patients, such as a person trained to participate in a role-play situation or a computer-based mannequin device instead of real patients, in competency testing of hospice aides and allow individuals who are competency tested only in the tasks for which they will be assigned to function as hospice aides.
(D) Not discontinue or diminish the hospice care provided to the individual because of the inability of the individual to pay or receipt of medicaid reimbursement for such care.
(E) Arrange for another individual or entity to furnish services to the individual in accordance with 42 C.F.R. 418.56 (October 1, 2023) when the designated hospice cannot provide services to the individual. This arrangement should include a signed agreement which shall remain on file at the hospice agency.
(F) Assume responsibility for the professional management of the individual's hospice care. Professional management involves the assessment, planning, monitoring, directing and evaluation of the individual's hospice care across all settings. The designated hospice should provide for and ensure the ongoing sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement.
(G) Facilitate concurrent care and services with other medicaid providers for which the individual under age twenty-one is eligible. As a responsibility for the professional management of the individual's hospice care, the designated hospice will:
(H) Have a signed agreement with the nursing facility, the intermediate care facility for individuals with intellectual disabilities (ICF-IID), the general inpatient facility, and/or the inpatient respite care facility in which the individual resides and/or receives services. The terms of the agreement should not violate the medicaid provider agreement as set forth in rule 5160-1-17.2 of the Administrative Code and should not violate the individual's freedom of choice of providers. This agreement should remain on file at the hospice agency and contain, at a minimum, the following:
(I) Ensure all necessary care and services set forth in this chapter are furnished to the individual and that such care and services are specified in the individual's plan of care in accordance with the standards set forth in 42 C.F.R. 418.56 (October 1, 2023) for:
(J) Designate a registered nurse who is a member of the interdisciplinary group to provide coordination of care and to ensure continuous assessment of each individual's and family's needs and implementation of the plan of care.
(K) Ensure hospice care is coordinated for an individual enrolled in a home and community based waiver program. A collaborative effort should occur between the designated hospice and the waiver case manager or the service and support administrator (SSA) as applicable to maintain a continuum of the overall care provided to the individual.
