How will my DSHS agency know I have elected hospice services?
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How will my DSHS agency know I have elected hospice services?

Revised April 3, 2012

How will my DSHS agency know I have elected hospice services?

When a client elects hospice services, the hospice agency provides notification to  the Medicaid Purchasing Administration (MPA) within five days of the election date using the 13-746 DSHS/ Medicaid hospice notification form. This includes the client’s name, the effective date the client elected hospice services, the type of hospice (Medicare or Medicaid), the name of the hospice provider  and the name of the facility if the client lives in a facility.   This also includes the daily rate.  (Note: Effective 7/1/2011 MPA will be known as the Healthcare Authority (HCA).


The hospice agency  will provide a signed release of information for the client in order to facilitate the coordination of services between the agency and the community services office (CSO) or home and community services (HCS).   The hospice agency checks for eligibility using the ProviderOne system.  If the client is not on assistance, the provider will assist the client in submitting an application for assistance with the DSHS/Medicaid Hospice notification and release of information. 


A hospice agency is responsible to verify a client’s eligibility with the client or with the appropriate HCS office or the Hospice specialty unit.  Once eligibility for medical coverage has been approved or denied, the approving office completes the DSHS section of the 13-746 form and faxes it back to the hospice agency.


When a client’s hospice status changes, the hospice agency faxes a hospice notification form with the updated information to MPA/HCA to be scanned into the client’s electronic record and indexed to the appropriate office.   Examples include: the client revokes hospice services, the client discharges from a hospice facility or the clients dies. If a client transfers to a different hospice agency, both the old and the new providers are responsible to provide notification to MPA/HCA. Once clients do elect Hospice, covered drugs and items are limited under the Hospice program.  Certain items are covered in the Hospice daily rate.  (WAC 182-551-1210).


Revocation of services. (WAC182-551-1360)  The Hospice provider is responsible to notify MPA/HCA of the revocation by completing and faxing a copy of the 13-746 DSHS/Medicaid hospice notification form.  The Hospice provider is responsible to give the client a copy of the revocation statement and inform the client that the revocation statement must be presented with the client’s current medical identification card when obtaining Medicaid covered services, supplies or both.  Client’s need to use this procedure until the department can remove Hospice coding out of the ProviderOne claims payment system.

Modification Date: April 3, 2012