Current through Register Vol. 24-18, September 15, 2024
(1) A hospice
agency must facilitate a client's continuity of care with nonhospice providers
to ensure that medically necessary care, both related and not related to the
terminal illness, is met. This includes:
(a)
Determining if the medicaid agency has approved a request for prescribed
medical equipment, such as a wheelchair. If the prescribed item is not
delivered to the client before the client becomes covered by a hospice agency,
the medicaid agency will rescind the approval. See WAC
182-543-9100(7).
(b) Communicating with other medicaid
programs and documenting the services a client is receiving in order to prevent
duplication of payment and to ensure continuity of care. Other medicaid
programs include, but are not limited to, programs administered by the
department of social and health services aging and disability services
administration (ADSA).
(c)
Documenting each contact with nonhospice providers.
(2) When a client resides in a nursing
facility, the hospice agency must:
(a)
Coordinate the client's care with all providers, including pharmacies and
medical vendors; and
(b) Provide
the same level of hospice care the hospice agency provides to a client residing
in their home.
(3) Once
a client chooses hospice care, hospice agency staff must notify and inform the
client of the following:
(a) By choosing
hospice care from a hospice agency, the client gives up the right to:
(i) Covered medicaid hospice service and
supplies received at the same time from another hospice agency; and
(ii) Any covered medicaid services and
supplies received from any other provider that are necessary for the palliation
and management of the terminal illness and related medical
conditions.
(b) Services
and supplies are not paid through the hospice daily rate if they are:
(i) Proven to be clinically unrelated to the
palliation and management of the client's terminal illness and related medical
conditions (see WAC
182-551-1210(3)
);
(ii) Not covered by the hospice
daily rate;
(iii) Provided under a
Title XIX medicaid program when the services are similar or duplicate the
hospice care services; or
(iv) Not
necessary for the palliation and management of the client's terminal illness
and related medical conditions.
(4) A hospice agency must have written
agreements with all contracted providers.
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, §182-551-1330, filed 4/17/12, effective 5/18/12.
11-14-075, recodified as §182-551-1330, filed 6/30/11, effective 7/1/11.
Statutory Authority:
RCW
74.08.090,
74.09.520. 05-18-033, §
388-551-1330, 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, §
388-551-1330, filed 4/9/99, effective
5/10/99.
