Procedures

Follow the steps below to determine ABD Medicaid eligibility under the Hospice Care COA.

Step 1 Accept the A/R’s Medicaid application Step 2 Verify the following through receipt of a Hospice Care Communicator (HCC) from the hospice agency: A/R’s medical prognosis (life expectancy) A/R’s (or PR’s) election of hospice services Date hospice care services began Step 3 If the A/Rs income includes SSI and not Institutionalized, STOP, deny application. SSI Hospice At Home A/R’s claims are directly billed to DCH through the Hospice agency. Step 4 Conduct an interview. Step 5 Determine basic eligibility, including Length of Stay (LOS) and Level of Care (LOC). Refer to Chapter 2200, Basic Eligibility Criteria. Step 6 Determine financial eligibility. Refer to Chapter 2500, ABD Financial Responsibility and Budgeting, for procedures on whose resources to consider and the resource limit to use in determining resource eligibility. Complete a Medicaid CAP budget to determine income eligibility. Refer to 2510 Medicaid Cap Budgeting . If A/R has income over the Medicaid Cap, refer to 2407 Qualified Income Trust . Step 7 Approve Medicaid on the system using the Hospice Care COA if the A/R meets all the above eligibility criteria. For an A/R receiving hospice care services in a nursing home, determine Institutionalized Hospice eligibility. See 2136 Institutionalized Hospice . Step 8 Notify the A/R of the case disposition via the system. Notify the hospice provider of the case disposition using the Hospice Care Communicator (HCC) and enter the hospice agency as an Authorized Representative in the system. Step 9 Verify at the following intervals through receipt of an HCC that the hospice care provider has received a signed statement from the A/R electing to continue hospice care services: by the end of the first 90-day period of hospice care by the end of the second 90-day period of hospice care every 60 days thereafter Do not approve Medicaid under the Hospice Care COA for any month in which the A/R will not receive hospice services from an approved hospice agency. If the A/R does not elect to continue hospice services at the intervals specified above, complete a CMD. Refer to the 2052 Continuing Medicaid Determination .