Ind. IHCP Hospice Services Provider Reference Module, Section 4, Discharge by Hospice Provider

The hospice member initiates hospice revocation, but the hospice provider initiates the process of hospice

discharge. Prior to discharging a patient, the hospice must obtain a written physician’s discharge order

from the hospice medical director. If a patient has an attending physician involved in their care, this

physician should be consulted before discharge and the physician’s review and decision included in the

discharge note.

A hospice provider that wishes to discharge a member is required to file a Medicaid Hospice Discharge

form (State Form 48734 [R/12-02]/OMPP 0008), available on the Forms page at in.gov/medicaid/providers.

The hospice medical director or the patient care coordinator are the only individuals included in the hospice

interdisciplinary team that may sign the Medicaid Hospice Discharge form. If safety is an issue, the Family

and Social Services Administration (FSSA) requires notification, as indicated on the Medicaid Hospice

Discharge form, of the circumstances surrounding the impending discharge.

If all hospice benefit periods preceding the date of the hospice discharge have been previously authorized,

the hospice provider can submit this form to the appropriate PA-UM contractor (see the IHCP Quick

Reference Guide for contact information). For FFS members, the completed form can be faxed to the FFS

PA-UM contractor or uploaded to the FFS PA-UM provider portal as a revision to the authorization. A

copy of the Medicaid Hospice Discharge form must also be sent to the member.

For members residing in nursing facilities, hospice providers are required to provide a copy of the Medicaid

Hospice Discharge form to the appropriate staff in the nursing facility to ensure that the form is included in

the clinical record the nursing facility maintains for the hospice member. This coordination ensures that

staff is aware of the exact date the hospice provider discharged the member.

The following process must be followed:

• Hospice providers must bill the IHCP for the hospice per diem for nursing facility room and board

for the hospice discharge date.

• Nursing facilities may resume billing the IHCP directly for nursing facility care for the dates of

service after the hospice discharge date.

Hospice providers are reminded that it is a violation of medical records standards to predate the hospice

discharge. The documented discharge date cannot precede the actual discharge date.

This discharge procedure applies for Medicaid-only members residing at home, Medicaid-only members

residing in nursing facilities, and dually eligible (Medicare and Medicaid) hospice members residing in

nursing facilities. Federal regulations require dually eligible hospice members residing in nursing facilities

to elect, revoke or change hospice providers, and to be discharged from hospice care, simultaneously under

the Medicare and Medicaid programs, because state Medicaid agencies pay for these nursing facility

residents’ room and board, as required by OBRA-89 and state regulations at 405 IAC 1-16-4. Hospice

providers are required to submit the appropriate paperwork under each program. Dually eligible hospice

members residing at home are not required to elect, revoke or change hospice providers, or to be discharged

from hospice care, under both programs, because Medicare pays for the hospice services and Medicaid has

no room-and-board payment responsibilities.

The following federal regulation pertains to hospice discharge.

42 CFR 418.26 Discharge from Hospice Care

(a) Reasons for discharge. A hospice may discharge a patient if:

(1) The patient moves out of the hospice’s service area or transfers to another hospice;

(2) The hospice determines that the patient is no longer terminally ill; or

(3) The hospice determines, under a policy set by the hospice for the purpose of addressing

discharge for cause that meets the requirements of paragraphs (a)(3)(i) through

(a)(3)(iv) of this section [42 CFR 418.26], that the patient’s (or other persons in the

patient’s home) behavior is disruptive, abusive, or uncooperative to the extent that

delivery of care to the patient or the ability of the hospice to operate effectively is

seriously impaired. The hospice must do the following before it seeks to discharge a

patient for cause:

(i) Advise the patient that a discharge for cause is being considered;

(ii) Make a serious effort to resolve the problem(s) presented by the patient’s

behavior or situation;

(iii) Ascertain that the patient’s proposed discharge is not due to the patient’s use of

necessary hospice services; and

(iv) Document the problem(s) and efforts made to resolve the problem(s) and enter

this documentation into its medical records.

(b) Discharge order. Prior to discharging a patient for any reason listed in paragraph (a) of

this section, the hospice must obtain a written physician’s discharge order from the hospice

medical director. If a patient has an attending physician involved in his or her care, this

physician should be consulted before discharge and his or her review and decision included in

the discharge note.

(c) Effect of discharge. An individual, upon discharge from the hospice during a particular

election period for reasons other than immediate transfer to another hospice –

(1) Is no longer covered under Medicare for hospice care;

(2) Resumes Medicare coverage of the benefits waived under 42 CFR 418.24(e); and

(3) May at any time elect to receive hospice care if he or she is again eligible to receive

the benefit.

(d) Discharge planning.

(1) The hospice must have in place a discharge planning process that takes into account

the prospect that a patient’s condition might stabilize or otherwise change such that

the patient cannot continue to be certified as terminally ill.

(2) The discharge planning process must include planning for any necessary family

counseling, patient education, or other services before the patient is discharged

because he or she is no longer terminally ill.