HOSPICE PROVIDER MANUAL

HOSPICE PROVIDER MANUAL

Chapter twenty-four of the Medicaid Services Manual Issued April 15, 2012

State of Louisiana Bureau of Health Services Financing

LOUISIANA MEDICAID PROGRAM

CHAPTER 24: HOSPICE SECTION: TABLE OF CONTENTS

ISSUED: 05/30/19 REPLACED: 03/26/19

PAGE(S) 5

CHAPTER 24 HOSPICE

TABLE OF CONTENTS

SUBJECT

SECTION

OVERVIEW

24.0

Criteria for Hospice Care

RECIPIENT REQUIREMENTS

24.1

Medicare and Medicaid (Dual Eligibles)

ELECTION OF HOSPICE

24.2

Reporting the Election of Hospice Care

Pending Medicaid Eligibles

Attending Physician

Election Statement Requirements

Legal Representatives

Definition of Relatives

Election Periods

Duration of Election

Change of Designated Hospice

Waiver of Other Medicaid Covered Services

Waiver Recipients

Service Coordination

Long Term-Personal Care Services

Community Choices Waiver

The Program of All-Inclusive Care for the Elderly

COVERED SERVICES

24.3

Core Services

Physician Services

Nursing Services

Medical Social Services

Counseling Services

Dietary Counseling

Bereavement Counseling

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Table of Contents

LOUISIANA MEDICAID PROGRAM

CHAPTER 24: HOSPICE SECTION: TABLE OF CONTENTS

ISSUED: 05/30/19 REPLACED: 03/26/19

PAGE(S) 5

Other Covered Services

Pastoral Care Short-Term Inpatient Care Medical Appliances and Supplies Hospice Aide and Homemaker Services Therapy Services

Other Items and Services Hospice Agency Service Requirements Waiver of Service Requirements Levels of Care

RESERVED

24.4

PROVIDER REQUIREMENTS

24.5

Licensure

Provider Responsibilities

Interdisciplinary Group

Plan of Care

Physician Certification and Narrative

Nurse Practitioners as Attending Physician

Certification of Terminal Illness

Certification of Initial period

Verbal Certification

Sources of Certification

Face-to-Face Encounters

BHSF Written Notice of Hospice Decision

Disaster Operations

PRIOR AUTHORIZATION PROCESS

24.6

Electronic Prior Authorization

Required Documentation

Prior Authorization ? 60 Day Period

Written Notice of Prior Authorization Decision

Reconsideration

HOSPICE REVOCATION, DISCHARGE AND TRANSFER

24.7

Revocations

Required Statement of Revocation

Re-election of Hospice

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LOUISIANA MEDICAID PROGRAM

CHAPTER 24: HOSPICE SECTION: TABLE OF CONTENTS

ISSUED: 05/30/19 REPLACED: 03/26/19

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Discharges

Reason for Discharge Documentation of Discharge Discharge/Revocation Due to Hospital Admit Service Availability upon Revocation or Discharge

Notice of Transfer

RECORD KEEPING

24.8

Contract Services

Review by State and Federal Agencies

Administrative Files

Personnel Records

Recipient Clinical Records

Confidentiality and Protection of Records

REIMBURSEMENT

24.9

Claim Form

Levels of Care

Routine Home Care (Revenue Code 651)

Continuous Home Care (Revenue Code 652)

Inpatient Respite Care (Revenue Code 655)

General Inpatient Care (Revenue Code 656)

Payment for Physician Services

Provision of Physician Services

Attending Physician

Consulting Physician

Payment for Long Term Care Facility Residents

Provider of First Choice

Non-Emergency Transportation for Non-Hospice Related Medical

Appointments

Emergency Transportation for Non-Hospice/Hospice Related Medical

Conditions

Medicare Coinsurance

Drugs and Biologicals Coinsurance (Dual Eligibles)

Respite Care Coinsurance (Dual Eligibles)

Telephone Calls and Consultations

Non-covered Days

Hospice Services to Medicaid/Medicare/Veteran's Eligible Beneficiaries

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LOUISIANA MEDICAID PROGRAM

CHAPTER 24: HOSPICE SECTION: TABLE OF CONTENTS

ISSUED: 05/30/19 REPLACED: 03/26/19

PAGE(S) 5

CLAIMS RELATED INFORMATION

24.10

Diagnosis Codes

Revenue Codes

Frequency of Billing

Claims Submission for Recipients Residing In the Home

Claims Submissions for Recipients Residing In a Long Term Care

Facility

Claims Submissions for Schedule (Room and Board ONLY)

Levels of Care Billing

Third Party Liability

Timely Filing Guidelines

PROGRAM MONITORING Review of Medical Eligibility Utilization Review Visits Requests for Clinical Records

24.11

APPEALS

24.12

RESERVED

24.13

ACRONYMS/DEFINITIONS/TERMS

24.14

RECIPIENT NOTICE OF

ELECTION/REVOCATION/DISCHARGE/TRANSFER APPENDIX A

Purpose of Form

Notifications and Type of Bill

Instructions for Completing the BHSF Form Hospice-Notice of Election

CERTIFICATE OF TERMINAL ILLNESS

APPENDIX B

HOSPICE DIAGNOSIS CODES

APPENDIX C

CONTACT/REFERRAL INFORMATION

APPENDIX D

UB-04 FORM AND INSTRUCTIONS Blank UB-04

APPENDIX E

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