Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-14A - Hospice Care
Section R414-14A-3 - Member Eligibility Requirements

(1) Hospice benefits are available to categorically and medically needy Medicaid-eligible individuals.

(2) A member, or representative if the member is incapacitated, must file an election statement with a hospice agency when choosing to use the hospice benefit.

(3) A member who has been assessed and provided with a written certification of terminal illness from a physician may obtain hospice services in accordance with 42 CFR 418.22.

(4) A member dually enrolled in Medicare and Medicaid must elect the hospice benefit for both Medicare and Medicaid in accordance with 42 CFR 418.21 and 418.24. The member must receive hospice coverage under Medicare primarily. Election for the Medicaid hospice benefit provides the member coverage for Medicare coinsurance and room and board expenses while admitted to a Medicare-certified nursing facility, intermediate care facility for people with an intellectual disability ICF/ID, or freestanding hospice facility.

(5) A primary diagnosis of debility or failure to thrive in adults does not meet eligibility criteria for the coverage of hospice services.