Ind. IHCP Hospice Services Provider Reference Module, Section 4, Change in Hospice Provider

Federal regulations at 42 CFR 418.30(a) specify that an individual or individual’s representative can

change, once in each election period, the designation of the particular hospice where hospice care is

received. 42 CFR 418.30(b) further specifies that this change of the designated hospice does not constitute

a revocation of the election for the period when it is made. The FSSA is legislatively mandated to model

the IHCP hospice benefit after the Medicare hospice benefit. As such, state regulations at

405 IAC 5-34-6(g) mirror the federal regulations cited in this paragraph.

A member, or representative of the member, who is not satisfied with a hospice provider can change hospice

providers during any benefit period. This change does not constitute a revocation of services. To change a

designated hospice provider, the member, or the member’s representative, must file a Hospice Provider

Change Request Between Indiana Hospice Providers form (State Form 48733 [R/12-02] OMPP 0009.

For Traditional Medicaid hospice members, the hospice provider can submit this form to the FFS PA-UM

contractor (as an authorization revision via their provider portal or by fax), as long as all hospice benefit

periods preceding the date of the hospice revocation were previously authorized. See the IHCP Quick

Reference Guide for contact information.

If the FFS PA-UM hospice analyst receives a hospice authorization request for the same dates of service that

have already been authorized in CoreMMIS for another hospice provider, the hospice analyst cannot process

the hospice authorization submitted by the new hospice provider until this discrepancy is resolved. The

hospice analyst resolves this issue as follows:

• The new hospice provider that submitted the hospice authorization with the duplicate dates of

service must coordinate with the original hospice provider that maintains the hospice authorization

for duplicate dates of service. When the new hospice provider obtains the Hospice Provider Change

Request Between Indiana Hospice Providers form, the new hospice provider must resubmit the

Hospice Provider Change Request Between Indiana Hospice Providers form to the FFS PA-UM

contractor with the election packet. The hospice analyst enters the day of the change in provider as

the first day of that hospice benefit period.

Note: For purposes of this explanation, “original hospice provider” refers to the provider

that first provided hospice services to the IHCP hospice member but that never

formally notified the FFS PA-UM contractor of any discharge or transfer to another

provider. “New hospice provider” refers to the provider that recently assumed the

management of the IHCP member’s hospice care.

• The original hospice provider and the new hospice provider must coordinate and agree on the

discharge and admission date in advance. Coverage cannot overlap and must be continuous.

• For hospice members residing in a nursing facility, hospice providers are encouraged to provide

a copy of the Hospice Provider Change Request Between Indiana Hospice Providers form to the

appropriate staff in the nursing facility to ensure that the form is included in the hospice member’s

nursing facility clinical record. This practice ensures that all nursing facility staff members are

aware of the change of hospice provider. To ensure better communication regarding reimbursement

issues between the hospice and the nursing facility, the hospice must develop coordination

procedures with appropriate staff in the nursing facility’s billing department so that the nursing

facility’s billing department is aware of the change in hospice provider.