Newsletter Vol. 2, No. 58

REQUIREMENTS: By September 2004 or upon first encounter with hospice patients in nursing facilities: (1) Billing team must update eligibility verification process to identify Medicaid-only hospice-eligible patients and obtain required Election of Hospice Benefits Statement (Form FD) before billing; (2) Nursing facility administrative staff must submit completed MCNH (Notification from Long Term Care Facility of Admission or Termination of a Medicaid Patient) form to Medicaid District Office (MDO) and County Welfare Agency (CWA) with 'DISCHARGED FROM NURSING FACILITY TO HOSPICE' notation in Remarks field when patient elects hospice; (3) Billing system must be configured to remove patients from Long Term Care Billing System on the date Form FD is signed and route billing to hospice provider instead of nursing facility; (4) Hospice providers must verify Medicare Part A assignment (if applicable) and obtain physician certification on Form FD before billing; (5) Front-line staff must issue limited-access MEI eligibility card with hospice notation and obtain hospice approval before authorizing non-hospice services (except physician services); (6) For GSHP or HMO members, obtain authorization number from HMO physician/case manager before providing services and include on claims; (7) Track therapeutic leave days (max 5/calendar year) and bed hold days (max 5 consecutive per hospitalization) separately for per diem reimbursement tracking. Consequences of inaction: Claims will be denied if patient status is not properly converted, services not authorized through HMO, or required forms/certifications are missing.