Hospice-Change of Circumstances

Revised June 16, 2011

Change of Circumstances

Active TANF,DL-X or other CNP medical programs   Hospice is a covered service for these programs so no program change is required. 

• Code the hospice provider as authorized representative type ‘NO’ on the AREP screen to receive copies of letters.   Hospice agencies need to get a termination notice if the Medicaid is closed.
• On the INST screen code ‘H’ Hospice on the HCB Service section with the Hospice service start date. Indicate ‘MA’ as approval source.    
• Using the DSHS/Medicaid hospice notification form, FAX a response to the Hospice Agency indicating the client has CNP Medical and has no participation requirement (the only time a client will have to pay toward the cost of care is when using the L22 institutional hospice rules).

Client is active on S95 and S99 (including spend-down in M status).  

• Add a L22 program to the existing active medical assistance unit to look at a program changeDetermine eligibility for the L22 hospice program following instructions under previous APPLICATIONS section.
• Shorten the certification end date to match the original certification end date of the original medical assistance unit.
• If approved, generate a hospice award letter (02-18) and ensure a copy is sent to the hospice provider.

See the special circumstances section  for instruction on active MN Medicaid client entering a nursing facility. 

• Follow Equal Access (EA) (formally known as necessary supplemental accommodation (NSA) procedures.

What if the 5-day notice indicates the client is deceased?

If the client was a recipient of CN medical or was receiving MN coverage because their spenddown had already been met, the FSS does not need to do a program change.  Follow instructions in the APPLICATIONS Section to respond back to the hospice agency using the DSHS/Medicaid Hospice notification.  Indicate that the client was eligible for hospice as a service and to bill according to their billing instructions with zero participation.

• If the client is deceased and we have a pending application, follow the application instructions listed above for either the L22 hospice program or non-institutional Medicaid CNP.  It is essential that an eligibility determination is made for these clients. The hospice agencies must still be notified timely of the approval or denial decision.
• If the client is deceased and there is no application prior to the date of death, a representative may apply on the client’s behalf.