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Authority: AS 47.05.010 AS 47.07.030 AS 47.07.040 7 AAC 140.275. Hospice care services. (a) Before the department will give prior authorization to and pay for hospice care services provided to a recipient in the recipient’s place of residence, the department must receive, no more than eight days after hospice care begins,

(1) a certification, signed by the recipient’s attending physician and the medical director of the hospice, that the recipient’s medical prognosis is a life expectancy of six months or less if the illness runs its normal course;

(2) a copy of the recipient’s care plan described in (d) of this section; and

(3) an election statement, signed by the recipient or the recipient’s representative, that includes

(A) the name of the designated hospice;

(B) an acknowledgment by the recipient, or the recipient’s representative, of an understanding of hospice care;

(C) the effective date of the election;

(D) an acknowledgment by the recipient, or the recipient’s representative, that for the duration of care, the recipient waives the recipient’s rights to hospice care by any other hospice unless arranged through the designated hospice, and waives the recipient’s rights to any other Medicaid-covered services related to the recipient’s terminal illness except for those provided by the designated hospice, an alternative hospice under arrangement with the designated hospice, or the recipient’s attending physician;

(E) an acknowledgment of the recipient’s option to revoke the election of hospice care at any time; and

(F) an acknowledgment of the recipient’s option to elect to change the designation of the hospice by submitting to both hospices a signed statement indicating the hospice from which care has been received, the newly designated hospice, and the date the change is effective; the recipient may only elect to change the designation of the hospice once in each election period as described in 42 C.F.R. 418.21 and 418.30, adopted by reference in 7 AAC 160.900.