Hospice-Overview
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Hospice-Overview


Revised June 25, 2012



Purpose: To provide an overview of the Hospice program and explain how to correctly determine eligibility for Hospice

Overview for Hospice

Hospice is a 24-hour intermittent program coordinated by a hospice interdisciplinary team for persons with a terminal illness and a prognosis of six months or less to live.   The hospice program allows the terminally ill client to choose physical, pastoral/spiritual and psychosocial comfort, and palliative care rather than cure.   Hospitalization is used only for acute symptom management.  

Hospice care is initiated by the choice of the client, family or physician.   The client’s physician must certify a client as appropriate for hospice care.    Hospice can be ended at any time by the client or family (revocation) by the hospice agency (discharge) or by the death of the client. 

Hospice care may be in a client’s home, in a medical institution including a hospice care center, nursing facility or in an alternate living facility.

For certain clients who are found eligible for Categorically Needy (CN) medical coverage or who already receive CN coverage, hospice care is a service which is covered by their medical service card.   When it is to the client’s advantage, Institutional Hospice rules are used to determine eligibility.  The program used for this is a L21 if the client receives an SSI cash grant or L22 if the client is SSI-related.  

The L21/L22 Hospice Program is not a waiver program; however the eligibility follows the same rules as the waiver program under WAC 388-515-1505 when countable income is under the Special Income Level  (SIL).  The special income level is 300% of the Federal Benefit Rate, (FBR).


General Eligibility-Who is eligible for Hospice?

WAC 388-503-0505 General eligibility for medical programs

  1. Definitions relating to Hospice are in  WAC 182-551-1010. A person who meets these general eligibility requirements:
    • Verification of age and identity
    • Citizenship or immigration status. Non citizen children are eligible to receive hospice services if they are eligible under a children's medical program
    • Residency
    • Social Security Number
    • Assignment of medical support rights
  2. Attains institutional status (WAC 388-513-1320) Institutional status is met when the 13-746 DSHS/Medicaid Hospice notification is received from the hospice agency with an election date indicated.
  3. Alien Medical Program (AMP) clients must have prior authorization for Hospice services by the Medicaid Agency's Chief Medical Consultant.  As a general rule, hospice services may be considered for non-citizen clients who are eligible for the State funded alien medical for cancer and dialysis program or who are eligible for Alien Emergent Medical in an inpatient hospital setting. 

Be sure to indicate on the referral if the request is for hospice in a nursing facility.  Add the name and address of the nursing facility to the referral form prior to sending to the medical consultant at MPA. Requests to MPA to authorize hospice coverage for AMP clients should be addressed to:

  • M.P.A

    Notification Unit

    P.O. Box 45506

    Olympia WA  98504-5506

    FAX:  360-586-1471

Chapter 182-551 WAC  describes the Hospice program as a service


NOTE:

Refer to Alien Medical Programs (AMP) for clients not meeting citizenship requirements and needing Hospice services.  Hospice Providers must get pre-approval from MPA in order to bill services under alien medical programs. 

Modification Date: June 25, 2012