Texas Administrative Code
Title 26 - HEALTH AND HUMAN SERVICES
Part 1 - HEALTH AND HUMAN SERVICES COMMISSION
Chapter 266 - MEDICAID HOSPICE PROGRAM
Subchapter B - UTILIZATION REVIEW
Section 266.205 - Election of Hospice Care

Universal Citation: 26 TX Admin Code ยง 266.205

Current through Reg. 49, No. 38; September 20, 2024

(a) Filing an election statement. An individual who meets the eligibility requirements for hospice care may elect hospice by filing the Individual Election/Cancellation/Update Form with a particular hospice. If the individual is physically or mentally incapacitated, the individual's representative may file the form. If the individual is dually eligible for Medicaid and Medicare, the individual must elect the Medicaid and Medicare hospice benefit at the same time.

(b) Content of election statement. The election statement must include the following:

(1) identification of the particular hospice that will provide care to the individual;

(2) the individual's or representative's acknowledgment that the individual or representative has been given a full explanation of the palliative rather than curative nature of hospice care as it relates to the individual's terminal illness;

(3) acknowledgment that certain Medicaid services, as set forth in subsection (d) of this section, are waived by the election;

(4) the effective date of the election, which may be the first day of hospice care or a later date, but must be no earlier than the date of the election statement; and

(5) the signature of the individual or representative.

(c) Duration of election. An election to receive hospice care will continue through the initial election period and the subsequent election periods without a break in care as long as the individual:

(1) remains in the care of a hospice; and

(2) does not revoke the election under the provisions of § 266.207 of this subchapter (relating to Revoking the Election of Hospice Care).

(d) Waiver of other benefits. For the duration of an election of hospice care, an individual 21 years of age or older waives all rights to the following Medicaid services:

(1) hospice care provided by a hospice other than the hospice designated by the individual unless the care is provided under arrangements made by the designated hospice; and

(2) any Medicaid services related to the treatment of the terminal condition for which hospice care was elected, or a related condition for which the hospice care was elected, or that are equivalent to hospice care except for services:
(A) provided by the designated hospice;

(B) provided by another hospice under arrangements made by the designated hospice; or

(C) provided by the individual's attending physician if that physician is not an employee of the designated hospice or receiving compensation from the hospice for those services.

(e) Re-election of hospice benefits. If an election has been revoked in accordance with § 266.207 of this subchapter, the individual, or the individual's representative, if the individual is mentally or physically incapacitated, may at any time file an election in accordance with this section.

(f) Record retention. The hospice must retain copies of all election forms in the hospice record for the individual and the individual's nursing facility or ICF/IID record, if applicable. Providers must meet the record retention requirements specified in 40 TAC Chapter 49 (relating to Contracting for Community Services).

(g) The hospice must submit the Individual Election/Cancellation/Update Form to the TMHP Long Term Care Online Portal.

Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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