Ga. Medicaid Part II Policies & Procedures for Hospice Services § 706

The hospice agency may discharge (not revoke) an individual for any of the following reasons:

706.1. Individual is determined to have a prognosis greater than six (6) months due to

improvement in the condition, in which case the member cannot be recertified.

706.2. Individual moves out of the hospice agency’s geographically defined service area.

706.3. The member transfers to another hospice agency.

706.4. The safety of the individual or hospice agency staff is compromised; or

706.5. The member dies. (Effective: 07/01/2014, submission of a hospice discharge form,

DMA-524, is required to be submitted to Gainwell Technologies for the formal

discharge of the member. This includes a discharge due to death)

The hospice agency must clearly document in the clinical record and explain on the discharge form

the situation(s) surrounding the discharge of the individual when safety issues are the cause. The

hospice agency must make every effort to resolve these problems satisfactorily before discharge

becomes an option. All efforts to resolve the problem(s) must be clearly documented in detail in the

member’s medical record and the hospice must notify the Division in writing using the hospice

discharge form in Appendix C and the State Survey Agency of the circumstances surrounding the

impending discharge. The hospice agency must complete the Hospice Care Communicator notifying

DFCS of the discharge. The hospice may need to make appropriate referrals to other relevant

state/community agencies as appropriate (e.g. Adult Protective Services).

The individual forfeits hospice coverage for any remaining days in that election period.

It is the responsibility of the hospice agency to advise the individual when possible, regarding

discharge from hospice services. The hospice agency must maintain the discharge form in the

individual’s medical record at the agency.

When discharging an individual, the hospice agency must complete a Hospice Discharge Form. The

discharge form must include at a minimum the items of information listed below:

706.6. Identification of the hospice agency.

706.6.1. The effective date of discharge.

706.6.2. The Social Security number and the date of birth of the individual; The

Medicaid and Medicare number (if applicable).

706.6.3. The reasons for discharge.

706.6.4. Documentation of explanation of discharge to individual/representative

and acknowledgement by the individual or representative.

706.6.5. Documentation of attempt to inform individual/representative of reason

for discharge.

706.6.6. Signature of the individual/representative when possible.

706.6.7. Signature/date of hospice representative completing the form.

The effective date of discharge cannot be a date earlier than the date the hospice representative

completed the form. The only exception is the situation in which a patient relocates outside the

agency’s defined service area without informing the agency. The hospice agency must maintain the

discharge form in the individual’s record at the agency. Once a hospice chooses to admit a Medicaid

member, the agency may not automatically or routinely discharge the member at its discretion, even

if the care promises to be costly or inconvenient. A hospice agency cannot demand or request the

member revoke their hospice election. The Division of Medical Assistance requires that the

Medicaid specific hospice discharge form found in Appendix C be used for individuals who are

Medicaid eligible and are discharged hospice services.