Hospice and ADSA programs
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Hospice and ADSA programs

Revised May 2, 2011

ADSA Programs (HCS and DDD Waivers)

  • Waiver programs such as HCS COPES, PACE, MMIP, MNRW, MNIW and DDD Waiver programs take precedence over Hospice. ACES is coded under the primary Waiver service and participation is applied toward the Waiver program first.
  • Indicate the Hospice agency on the AREP for the L21/L22 waiver program (such as COPES that is already active). 
  • Indicate the hospice service on the INST screen along with the COPES service.  Report to the case manager of the Waiver service the client has elected Hospice. Send a copy of the DSHS/Hospice Notification form to the Social Worker/case manager of record so they have information on the Hospice Provider to coordinate services.  It is important that services are coordinated between the Hospice provider and the DSHS agency providing a waiver or medicaid personal care (MPC) service so there is no duplication of services. 
  • For clients who elect Hospice while in a Nursing Facility, ACES is coded as Hospice in a Nursing Facility on the INST screen.  Add the hospice information in the HCBS field on the INST screen.  This will add the hospice indicator to the STAT screen and the case will remain an "L" track case (L01/L02,L95).  A Hospice award letter will need to be hand generated for SSI and GA-X in a Nursing Home. (02-18)    
  • Use the short stay screen for a hospice election in a NF when the client is already on Medicaid and the election and end of hospice service is under 30 days. (see example #1 below).
  • Use the short stay screen for a hospice election when a client is active on a medicaid program and is admitted into a hospice care center or hospice NF admission 30 days or less. 

 

See ACES instructions


EXAMPLE

Example #1. Active client on L02 in nursing home elects Hospice

Elects Hospice on 10/2/2008 and dies or revokes hospice on 10/15/09.

This case does not need to be changed in order to issue a Hospice award letter. 

Use the short stay screen to issue a Hospice award letter from 10/2/2008 to 10/15/08 and process. 

EXAMPLE

Example #2 Active MNRW client on G95 elects Hospice

In this example, the client remains in the ALF under the MNRW program.  The Hospice agency will bill the medicaid agency with hospice as a service.  The MNRW program remains the priority program.  Code the hospice service on the INST screen. 

EXAMPLE

Example #3. Active MNRW client on a G95 elects hospice and enters a hospice care center

In this example, client was receiving MNRW in an ALF and is active on the G95 program.

On 10/10/08 the client is discharged from the ALF and MNRW service into a Hospice Care Center. 

On 10/20/08 the client dies. 

The financial worker is doing the work on 10/21.

Use the short stay screen on the active G95 to issue the hospice award letter. If the client were at a home setting or in an ALF receiving a Waiver service, the Hospice agency does not need an award letter to bill.  The Waiver takes precedence.

Once the client goes into a hospice care center or a nursing home under Hospice, an award letter is needed to bill.  The short stay screen can be used for those admissions into a medical institution under the Hospice program and it is under 30 days. 

EXAMPLE

Example #4 Active COPES client electing hospice, client in their own home.

In this example hospice is coded on the INST screen along with the COPES service.  The COPES Waiver is the priority program and any participation would go to the COPES provider.  A hospice award letter is not issued or needed, the hospice provider bills the department as a hospice service.

EXAMPLE

Example #5. Active L02 in a nursing home elects Hospice.

Client elected hospice on 10/2/2008 in the NF.  Financial worker is processing the change on 10/23/08. 

In this example, we would add the hospice information to the INST screen which will add the Hospice flag to the STAT screen.  The case should be transferred to the specialized medical hospice unit at ESA.

EXAMPLE

Example #6. MNIW client on active S95 and elects Hospice

In this example, the Hospice would be paid as a service as any Waiver program such as MNIW would be a priority program over Hospice.  An client responsibility would be paid to the MNIW provider.

The program stays as a S95 in ACES. 

See ACES instructions

 

See ACES instructions for short stays

 

See EAZ manual instructions for short stays

Modification Date: May 2, 2011