Effective January, 1, 2016: All hospice providers will be impacted by Hospice Payment Reform. Please see Information Release MA15-08, "Hospice Payment Reform Provider Education" and the revised "Hospice Notification Form" under the Resources section of this page.
Hospice agencies are required to notify Medicaid for all Medicaid, Medicare or commercial insurance participants electing Hospice services. 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 provider agency is responsible to track, and meet, all due dates. (Note: Medicare’s certification periods are different.)
All status changes related to hospice care should be submitted within fifteen business days to the Medical Care Unit. Status changes must be submitted on the Hospice Notification Form with documentation for eight month Election or Recertification periods. 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 primary hospice diagnosis ICD code submitted to Medical Care Unit must match the terminal illness diagnosis code used to bill Medicaid.
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.