Hospice

Created on: 
Jan 06 2016

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is Hospice?

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 on Hospice as a Home and Community Based Services (HCBS) or Program, see Apple Health eligibility manual - Hospice - Index

Who is eligible for Hospice services?

A person who is eligible for a Categorically Needy (CN) or Medically Needy (MN) medical program is eligible to receive hospice care. Apple Health eligibility manual - Hospice - Overview

Online Processing

How do I add Hospice service to a client active on Categorically Needy (CN) or Medically Needy (MN) medical?

To add Hospice services to a client that is already active on CN or MN medical, take the following actions: 

  1. From the Case Actions page:
  • Select the [month and year] the client elected hospice from the Benefit Month drop down menu and click the Start Changes link. 
  1. On the Contact Information page, add an Authorized Representative/Payees and complete the following:
  • Type drop down menu - Select the appropriate [authorized representative]
  • Name fields - Enter the [hospice agency name] or the [authorized representative name] in the First MI Last fields
  • Attn/Firm field - Enter the [representative's name]
  • Address fields - Enter the [representative's address]
  1. On the Institutional Care page, add a Home and Community Based Service page and complete the following:
  • Type drop down menu - Select Hospice (H).
  • Provider ID field - Enter the [provider number]. To find the provider’s ID number, click the Search link to access the Provider Search pop up window. Enter the provider's name and city in the correct fields and click Search.
  • Start Date field - Enter the [date the client elected hospice].
  • Approval Source drop down menu - Select the appropriate approval source code.
  • Payment Auth Date field - Enter the [date payment is to begin]
  • Private Rate field - Enter the [provider’s private daily rate]. To find the provider's private rate, call the facility.
  • State Rate field - Enter the [provider’s state daily rate]. To find the provider’s state rate, click the Details link next to the Provide ID field. See Vendor Payment – How do I inquire on a vendor?
  1. Click on Eligibility and then click the Commit Changes button to commit the data.

How do I add Hospice as a program?

Clients electing Hospice as a program in an institutional setting and are not receiving any other higher priority services should be screened for Categorically Needy - PACE or Institutional Hospice - SSI Recipients (L31) or Categorically Needy - PACE or Hospice - SSI Related (L32). For more information, see Categorically Needy - PACE or Institutional Hospice - SSI Recipients (L31) or Categorically Needy - PACE or Hospice - SSI Related (L32).

Clients electing Hospice as a program in a NON-Institutional setting and are not receiving any other higher priority services should be screened on Categorically Needy LTC in a Medical Facility - SSI Related (L02) medical. For more information see Categorically Needy LTC in a Medical Facility - SSI Related (L02)

NOTE: Workers may need to add a program to clients not receiving Categorically Needy (CN) or Medically Needy (MN) medical programs.

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 Apple Health eligibility manual - WAC 182-513-1380 Determining a person’s financial participation in the cost of care for long-term care (LTC) services. The 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 Apple Health eligibility manual - WAC 182-515-1505 Home and community services (HCS) authorized home and community based (HCB) waiver services. If the client has both HCS Waiver and hospice services coded concurrently, ACES assigns the participation to the HCS Waiver provider.

Mainframe Processing

How do I add Hospice service to a client active on Categorically Needy (CN) or Medically Needy (MN) medical?

To add Hospice services to a client that is already active on CN or MN medical, take the following actions: 

  1. From the AMEN screen, update the following fields and <transmit>;
  • Selection field - Enter Option [R] - Interim/Hist Change.
  • AUID or Client ID field - Enter the [AUID or CLID].
  • Benefit Month (MM YY) field - Enter the [month and year] that the client elected hospice.
  1. On the ADDR screen:
  • Auth Rep/Payee field - Enter a [Y] - Yes
  1. On the AREP screen:
  • Rep Type field - Enter the appropriate [authorized representative].
  • Corp Name field - Enter the [hospice agency name]; 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 DDA case manager from the AREP screen as the waiver service is the priority program.
  • Attn/Firm field - Enter the [representative's name]
  • Address fields - Enter the [representative's address]
  1. On the INST screen, in the Home Community Based Service section:
  • HCBS Type field - Enter the [H]- Hospice on the next line.
  • Provider ID field - Enter the [provider number]. To find the provider’s ID number press <F20> to go to the MMEN screen. Enter option [A] - Vendor Name List. For more information, see Vendor Payment - How do I inquire on a vendor in Mainframe?
  • Start Date field - Enter the [date the client elected hospice].
  • Apprvl Source field - Enter the [HCBS approval source code].
  • Payment Auth Date field - Enter the [date payment is to begin].
  • Private Rate field - Enter the [provider’s private daily rate]. Call the facility to get the current private rate.
  • State Rate field - Enter the [provider’s state daily rate].
  1. Call DONE and commit the data.

How do I add Hospice as a program?

Clients electing Hospice as a program in an institutional setting and are not receiving any other higher priority services should be screened for Categorically Needy - PACE or Institutional Hospice - SSI Recipients (L31) or Categorically Needy - PACE or Hospice - SSI Related (L32). For more information, see Categorically Needy - PACE or Institutional Hospice - SSI Recipients (L31) or Categorically Needy - PACE or Hospice - SSI Related (L32).

Clients electing Hospice as a program in a NON-Institutional setting and are not receiving any other higher priority services should be screened on Categorically Needy LTC in a Medical Facility - SSI Related (L02) medical. For more information, see Categorically Needy LTC in a Medical Facility - SSI Related (L02)

NOTE: Workers may need to add a program to clients not receiving Categorically Needy (CN) or Medically Needy (MN) medical programs.

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 Apple Health eligibility manual - WAC 182-513-1380 Determining a person's financial participation in the cost of care for long-term care (LTC) services. The participation is assigned to the hospice provider, not the medical facility, unless the medical facility is a (HC) - Hospice Care Center.

Participation for hospice services received in a client’s home is determined according to the Apple Health eligibility manual - WAC 182-515-1505 Home and community services (HCS) authorized home and community based (HCB) waiver services. If the client has both HCS Waiver and hospice services coded concurrently, ACES assigns the participation to the HCS Waiver provider.

 

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.