Basic Considerations
To be eligible under the Institutionalized Hospice COA, an A/R must meet the following conditions:
The A/R is receiving or elects to receive Hospice Care services while residing in a Medicaid participating nursing home.
The A/R has a medical prognosis of six months or less life expectancy.
The A/R is receiving Hospice Care services from an approved hospice care provider.
The A/R meets the Length of Stay (LOS) and Level of Care (LOC) basic eligibility criteria.
The A/R meets all other basic and financial eligibility criteria required for the Hospice Care COA.
A DMA-59 is not required unless the A/R leaves hospice care and remains in the nursing home under Medicaid.
Hospice care services are provided to the A/R by a DMA certified hospice agency. Effective April 1, 2003, Medicaid eligible persons who receive or elect hospice care services while residing in a nursing home must pay a monthly patient liability amount to the hospice care provider. The hospice care provider will pay to the nursing home the patient liability amount.
DMA reimburses only those medical services provided by the hospice care agency. These recipients receive a Medicaid card that identifies them as Hospice recipients, with a notice to medical service providers that all claims must be submitted through the hospice agency.