Hospice
DSHS Home Page
 
Search     for:


DSHS Home    Acronyms    Alerts    Screens    WAC Number Index    WCCC

Hospice


Revised June 20, 2014



What is hospice?

 

Who is eligible for hospice services?

 

What medical coverage group do I use for a client who is eligible to receive hospice care?

 

How do I add hospice services to a client receiving LTC services?

 

How do I enter hospice as a short stay?

 

How is hospice participation determined?

 


 

What is hospice?

 

·         Hospice provides a terminally ill client a variety of treatment alternatives while in their home, medical institution, nursing facility including a hospice care center or an alternate living facility. For more information,  see EAZ Manual – Medical Assistance Programs – Hospice.

 

Who is eligible for hospice services?

 

·         Terminally ill clients who meet the criteria in EAZ Manual – Medical Assistance - Hospice.

 

What medical coverage group do I use for a client who is eligible to receive hospice care?

 

·         Clients who are eligible for or receiving non-institutionalized categorically needy (CN) or medical needy (MN) coverage are eligible for hospice services on their non-institutional medical AU.

 

o    For more information, see EAZ Manual – Hospice – When am I eligible for Hospice as a service.

 

o    For more information on screening and processing an L21 or L22 AU, see Categorically Needy waiver or Hospice services – SSI recipient (L21)  and Categorically Needy waiver or Hospice services – SSI related (L22).

 

·         The L-track (L21, L22) should be used for clients who are eligible for hospice on a CN program using institutional rules.

 

o    For more information, see EAZ Manual – When am I eligible for a Hospice Program following Institutional Medicaid Rules and EAZ Manual – Hospice – Applications – Client is Not Otherwise Eligible for a Non-institutional CNP Program.

 

·         Clients who do not meet eligibility requirements for hospice on a CN program must reside in a medical facility to have their eligibility considered for a MN Hospice (L95, L99) program.

 

o    For more information, see WAC 182-513-1395 Determining eligibility for institutional or hospice services for individuals living in a medical institution under the medically needy (MN) program.

 

How do I add hospice services to a client receiving LTC services?

 

1.    From the AMEN, select Option R – Interim/Hist Change.

 

o    Enter the [AUID or CLID] in the AUID or Client ID field.

 

o    Enter the [month and year] the client elected hospice in the Benefit Month (MM YY) field.

 

2.    On the ADDR screen:

 

o    Enter a [Y] – Yes in the Auth Rep/Payee field.

 

3.    On the AREP screen:

 

o    Enter the [appropriate authorized representative] in the Rep Type field.

 

o    Enter the [hospice agency name] in the Corp Name field; or the [AREP Name] in the F Name MI L Name fields.

 

¨        If the client is receiving waiver services do not remove the (HCS/AAA or DDD) case manager from the AREP screen as the waiver service is the priority program.

 

o    Enter the [representative’s name] in the appropriate address fields.

 

4.    On the DEM1 screen:

 

o    Enter [HC] – Hospice Care Center in the Liv Arng field, only If the client has entered a Hospice Care Center.

 

5.    On the INST screen, in the Facility section:

 

¨        Enter the [type of facility] in the INST Type field. The facility type must be from the same subset as the living arrangement coded on the DEM1 screen.

 

¨        Enter the [provider number] in the Provider ID field if the provider is one of the following facility types: MD – Nursing Facility – Medicaid, ME – Nursing Facility – Medicare, HS – Hospital, IM – Institution for Mentally Diseased or HC – Hospice Care Center.

 

·         Hospitals and Institutions for Mentally Diseased do not have provider numbers.

 

¨        Enter the [date the client elected hospice] in the Entry Date field.

 

¨        Enter the [O - Hospice] in the Level Care field.

 

¨        Enter the [date payment to the facility should begin] in the Payment Auth Date field. This is the date the hospice was elected and services are approved and displays on the award letter.

 

¨        Enter the [facilities private daily rate] in the Private Rate field. Contact the facility for rate information.

 

¨        Enter the [facilities state daily rate] in the State Rate field. Press <F20> to access the MMEN for state rates for providers.

 

6.    On the INST screen, in the Home Community Based Service section:

 

o    Enter the [Y] – Yes in the Delete field to remove the old HCBS information.

 

o    Enter the [H- Hospice] in the HCBS Type field on the next line.

 

o    Enter the [provider number] in the Provider ID field. To find the provider’s ID number press <F20> to go to the MMEN. Enter option [A] – Vendor Name List. See Vendor Payment – How do I inquire on a vendor?

 

o    Enter the [date the client elected hospice] in the Start Date field.

 

o    Enter the [HCBS approval source code] in the Apprvl Source field.

 

o    Enter the [date payment is to begin] in the Payment Auth Date field.

 

o    Enter the [provider’s private daily rate] in the Private Rate field. Call the facility to get the current private rate.

 

o    Enter the [provider’s state daily rate] in the State Rate field. To find the provider’s state rate press <F20> to go to the MMEN. Enter option [A] – Vendor Name List. See Vendor Payment – How do I inquire on a vendor?

 

7.    Call DONE and commit the data.

 

How do I enter hospice as a short stay?

 

·         To enter hospice as a short stay, see Short Stay.

 

How is hospice participation determined?

 

·         Participation in the cost-of-care for hospice services received in a medical facility is determined according to the WAC 182-513-1380 Determining a client’s financial participation in the cost of care for long-term care (LTC) services.

 

o    Participation is assigned to the hospice provider, not the medical facility, unless the medical facility is a Hospice Care Center [HC].

 

·         Participation for hospice services received in a client’s home is determined according to the WAC 182-515-1505 Long-term care home and community based services and hospice.

 

o    If the client has both COPES and hospice services coded concurrently, ACES will assign the participation to the COPES provider.

 

Modification Date: June 20, 2014