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Revised January 8, 2013 |
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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?
· 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 EAZ Manual – 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 EAZ Manual – 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 EAZ Manual – WAC 182-515-1505 Long-term care home and community based services and hospice. (Table of contents WAC).
o If the client has both COPES and hospice services coded concurrently, ACES will assign the participation to the COPES provider.
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Modification Date: January 8, 2013