Ill. HFS Handbook for Hospice Agencies, Topic K-211.2

An individual must file an election statement with the hospice. The election

statement must include the following items:

1. Identification of the hospice that will provide care.

2. The individual’s or legal representative’s acknowledgement that he or she has

been given a full understanding of hospice care as an alternative to traditional

covered Medicaid services and has made an informed decision to elect

hospice care.

3. Waiver of all rights to Medicaid payments for the following services for the

duration of the election of hospice care:

•

Hospice care provided by a hospice other than the hospice designated

by the individual (unless provided under arrangements made by the

designated hospice); and

•

Any Medicaid services that are related to the treatment of the terminal

condition for which hospice care was elected or a related condition, or

services that are equivalent to hospice care, except for:

• Services provided by the designated hospice;

• Services provided by another hospice under arrangements made

by the designated hospice;

• Services provided by the individual’s attending physician if that

physician is not an employee of the designated hospice or

receiving compensation from the hospice for those services;

• Room and board by a nursing facility if the individual is a

resident.

•

Services provided outside the hospice benefit for patients 21 years of

age and older, as identified in 89 Ill. Admin. Code section 140.469(h).

4. The effective date of the election.

5. The signature of the individual or legal representative. In the event that the

patient is not physically or mentally able to sign the Notice of Election, his or

her legal representative may do so on his or her behalf.

Section 2302 of the Affordable Care Act, titled “Concurrent Care for Children,”

amended sections 1905(o)(1) and 2110(a)(23) of the Social Security Act to remove

the prohibition of receiving curative treatment upon election of the hospice benefit for

a Medicaid or Children’s Health Insurance Program (CHIP) eligible child.

Accordingly, election statements for children through age 20 must differ in that they

must inform pediatric patients that they are entitled to all Medicaid benefits

concurrently with hospice care.

The hospice must notify the Department after an eligible participant elects hospice

care by completing the HFS 1592 - Notification to HFS of Illinois Medicaid Hospice

Benefit Election - Initial Election Period.

Do not use the institutional claim format for notification of election to the

Department. This may result in delaying the payment process or rejection of a claim

for service.

Hospices are strongly encouraged to notify the Department promptly, as delay in

notification can impact the hospice payment as well as other providers’ payment.

Incoming HFS 1592 participant election information will be entered with an

ending date that is 180 days from the initial election date. The 180-day period

encompasses the initial two 90-day benefit periods.

Hospice providers will be required to submit the HFS 1593 - Notification to HFS of

Illinois Medicaid Hospice Benefit - Continuing Benefit Period and Recertification of

Terminal Illness for each 60-day extension period of election. These extensions

should be submitted no earlier than 15 days prior to the ending date of the current

period, in order to prevent the election from expiring. If the hospice election expires,

hospice payments will end and any nursing home room and board payments from

the Department will be made to the nursing home, not to the hospice provider.

After a hospice patient dies or is discharged, the hospice must complete the HFS

1594 – Notification to HFS of Patient Discharge from Hospice Care.

Allow two (2) weeks after submitting one of the hospice forms before submitting a

claim for service. Claims submitted prior to the Department’s update of multiple data

segments will cause the claim to reject. The hospice must then rebill before payment

can be adjudicated.

It is extremely important that the hospice agency notifies the Department of

election information in a timely manner so as not to disrupt payment to the

hospice or its associated nursing homes.

If a patient’s eligibility for medical assistance is cancelled, the database will

automatically enter a hospice end date. If the patient re-applies for medical

assistance and is approved, and the patient is still under hospice care, a new HFS

1593 notification will need to be submitted to the Department to update the hospice

election period on the Department’s file.

The HFS forms for notification of election/discharge may be mailed or faxed to the

Department. The mailing address is:

Illinois Department of Healthcare and Family Services

Bureau of Hospital and Provider Services

P. O. Box 19128

Springfield, Illinois 62794-9128

Attn: UB Billing Unit

The telefax number is 217-524-4283, Attn: UB Billing Unit