Procedures

Follow the steps below to determine ABD Medicaid eligibility under the Institutionalized Hospice 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 The date hospice services began Step 3 Conduct an interview. Step 4 Determine basic eligibility, including Length of Stay (LOS) and Level of Care (LOC). Refer to Chapter 2200, Basic Eligibility Criteria. Step 5 Determine financial eligibility. Refer to Chapter 2500, ABD Financial Responsibility and Budgeting, for determining whose resources to consider and the resource limit to use. Step 6 If the A/R meets all the above eligibility criteria, approve Medicaid on the system. Step 7 Notify the A/R of the case disposition via the system. Notify the hospice provider of the case disposition and Patient Liability using the Hospice Care Communicator (HCC) and enter the hospice provider as an Authorized Representative in the system. Step 8 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 Institutionalized Hospice services: by the end of the first 90-day period of Institutionalized Hospice by the end of the second 90-day period of Institutionalized Hospice every 60 days thereafter

Do not approve Medicaid under the Institutionalized Hospice 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 Section 2052, Continuing Medicaid Determination.