Current through Register Vol. 24-18, September 15, 2024
(1) Hospice
coverage is available for two ninety-day election periods followed by an
unlimited number of sixty-day election periods. A client or a client's
authorized representative must sign an election statement to initiate or
reinitiate an election period for hospice care.
(2) The election statement must be filed in
the client's hospice medical record within two calendar days following the day
the hospice care begins and requires all of the following:
(a) Name and address of the hospice agency
that will provide the care;
(b)
Documentation that the client is fully informed and understands hospice care
and waiver of other medicaid and/or medicare services;
(c) Effective date of the election;
and
(d) Signature of the client or
the client's authorized representative.
(3) The following describes the hospice
certification process:
(a) When a client
elects to receive hospice care, the medicaid agency requires a hospice agency
to:
(i) Obtain a signed written certification
from a physician of the client's terminal illness; or
(ii) Document in the client's medical file
that a verbal certification was obtained and follow up a documented verbal
certification with a written certification signed by:
(A) The medical director of the hospice
agency or a physician staff member of the interdisciplinary team; and
(B) The client's attending physician (if the
client has one).
(iii)
Place the signed written certification of the client's terminal illness in the
client's medical file:
(A) Within sixty days
following the day the hospice care begins; and
(B) Before billing the medicaid agency for
the hospice services.
(b) For subsequent election periods, the
medicaid agency requires:
(i) A hospice
physician or hospice nurse practitioner to:
(A) Have a face-to-face encounter with every
hospice client within thirty days prior to the one hundred eightieth-day
recertification and prior to each subsequent recertification to determine
continued eligibility of the client for hospice care. The medicaid agency does
not pay for face-to-face encounters to recertify a hospice client;
and
(B) Attest that the
face-to-face encounter took place.
(ii) The hospice agency to:
(A) Document in the client's medical file
that a verbal certification was obtained and follow up a documented verbal
certification with a written certification signed by the medical director of
the hospice agency or a physician staff member of the hospice agency;
(B) Place the written certification of the
client's terminal illness in the client's medical file before billing the
medicaid agency for the hospice services; and
(C) Submit the written certification to the
medicaid agency with the hospice claim related to the
recertification.
(4) When a client's hospice coverage ends
within an election period (e.g., the client revokes hospice care), the
remainder of that election period is forfeited. The client may reinstate the
hospice benefit at any time by providing an election statement and meeting the
certification process requirements.
Statutory Authority:
RCW
41.05.021, Section 2302 of the Patient
Protection and Affordable Care Act of 2010 (
P.L.
111-148), and Section 1814(a)(7) of the Social
Security Act. 12-09-079, §182-551-1310, filed 4/17/12, effective 5/18/12.
11-14-075, recodified as §182-551-1310, filed 6/30/11, effective 7/1/11.
Statutory Authority:
RCW
74.08.090,
74.09.520. 05-18-033, §
388-551-1310, filed 8/30/05, effective 10/1/05. Statutory Authority:
RCW
74.09.520,
74.08.090,
42 C.F.R.
418.22 and
418.24. 99-09-007, §
388-551-1310, filed 4/9/99, effective
5/10/99.
