The Medical Care Unit is responsible for reviewing hospice notifications for Medicaid. General instructions and important points are outlined below. Forms, the Provider Handbook, and more information is available through the links to the right.
Hospice agencies are required to notify Medicaid for all Medicaid participants electing Hospice services. If Medicare or a commercial insurance is the primary payer, the hospice agency must still notify Medicaid. The Centers for Medicare and Medicaid Services (CMS) require the hospice agency to simultaneously notify both programs regarding election, recertification, discharge, revocation, or transfer between hospices, for participant’s who are dually eligible. Medicaid recertification periods are every eight months, and the hospice is responsible to track the due dates. (Medicare’s certification periods are different).
For all status changes related to hospice care, fifteen working days are allowed to obtain physician signatures and fax documents as noted on Hospice Notification Form to Medical Care Unit.
To allow processing within the Medicaid system and payment for hospice services please legibly complete the Hospice Notification Form and fax it to (877) 314-8779. Fill in Medicaid Provider Information, Participant Information, and fax the required documents for the eight month Election or Recertification period. Or, note an appropriate change in status on the Hospice Notification Form. Supporting documentation is not needed for notification of death, transfer, discharge (hospice chooses to end care if no longer meets eligibility criteria), or revocation (participant chooses to end care).
The Provider Handbook summarizes specific information regarding hospice issues and billing. The primary hospice diagnosis ICD-9 code submitted to Medical Care Unit must match the terminal illness diagnosis code used to bill Medicaid.
For more information or questions, please contact (208) 364-1818.