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State of Maryland Medical Assistance Manual Revised April 2014

e. Hospice Care in a Long-Term-Care Facility (Policy Alert 10-6) A resident of a long-term-care facility who has an illness that is expected to be terminal within six months may elect to receive hospice care. Hospice care includes some services not typically provided by nursing homes and not usually covered by Medical Assistance, such as spiritual counseling and social work services. A person receiving hospice care does not receive certain other services which would prolong life. Hospice providers are responsible for coordinating the patient’s care and insuring that all appropriate services are rendered. The amount the hospice provider is paid by Medical Assistance is based on the services the individual patient requires. A person who elects hospice care must receive treatment related to the terminal illness through the hospice provider only. The hospice provider is then responsible for making payments to all providers treating the patient’s terminal illness, including the nursing home. When a person is a resident in a LTCF and elects hospice care, eligibility is determined as for any other institutionalized person. A DHMH 257 approved by the UCA is required to verify admission to the LTCF and a level of care of at least intermediate. When a person is determined eligible for Medical Assistance and hospice care is elected, there are procedures in place to prevent further payments by Medical Assistance to the LTCF and to authorize payments to the hospice provider. These procedures will be carried out by the hospice provider, the LTCF and DHMH. No action other than the usual ongoing case maintenance is required by the LDSS. Hospice care is also provided to those who reside in their own homes or in hospice facilities. Eligibility for these persons continues to be determined under community M.A. rules. f. Recipients Admitted to Long Term Care Facilities and Institutions for Mental Disease (IMDs) (Policy Alert 10-7) If a MCO-enrolled recipient requires care from a nursing home, chronic care, or chronic rehab facility, the MCO must make the placement and cover the first 30 consecutive days of care. The MCO must obtain approval for the placement from the Utilization Control Agent (UCA). When an MCO properly places a recipient into long-term care and obtains appropriate approval from the UCA, the MCO submits a disenrollment request to DHMH. If the MCO does not take the required steps to obtain the UCA approval, any unapproved time may not be counted towards fulfilling the MCO’s 30-day obligation. This means the MCO may be responsible for paying for more than the first 30 days of care. When an MCO enrollee requires mental health services, clinical evaluation and assessment of services needed will be provided by the enrollee’s MCO. However, Maryland Health Partners, the Administrative Services Organization (ASO), authorizes all specialty mental health services. The MCO is not responsible for payment of any specialty mental health services, including inpatient admissions to an IMD.