Kan. Medical Assistance Program Hospice Fee-for-Service Provider Manual § 8400, Definitions

Certification of terminal illness

A statement signed by the physician certifying that the member has a medical prognosis with a

life expectancy of six months or less if the illness runs its normal course.

Election statement

A revocable statement signed by a member or his/her legal representative which is filed with a

particular hospice and consists of:

• Identification of the hospice selected to provide care to the member

• Acknowledgement that the member has been given a full explanation of hospice and the

palliative rather than curative nature of hospice care

• Acknowledgement by the patient that KMAP payment for other services related to the

terminal illness or related conditions are waived by the election of hospice care, with the

exception of those Home and Community Based Services (HCBS) services that cannot be

provided by the hospice provider

Note: Hospice providers are responsible for the coordination of all services and

communication with the HCBS case manager. Evidence of coordination with other case

managers should be reflected in the hospice plan of care.

• Effective date of the election period

• Signature of the member or his/her legal representative

Providers are required to enter hospice assignment or revocation information through the KMAP

website. Each provider must keep a hard copy of the hospice assignment or revocation

information on file. The hospice assignments must be entered within five calendar days of the

date the member signed the election statement.

From the Main Menu of the KMAP website, providers select the Hospice Election option to

access the Inquiry and Submit windows. The Inquiry option allows providers to view and update

existing hospice election assignments; the Submit option allows a new hospice election

assignment to be submitted.

Election statement

When submitting a new hospice election, providers use the Verify/Add/Change LTC Facility

button on the Hospice Election Assignment window to enter the NPI information for members

who reside in a nursing facility or hospital. Help windows are available from the toolbar for each

hospice window. Contact Customer Service at 1-800-933-6593 or 785-274-5990 for questions or

help using the KMAP website.

As a reminder, there is a five-day grace period starting at the time of admission or election to

hospice care during which the provider must submit a hospice election through the KMAP

website. The website guides the user through the process of electronic submission.

If the entry date of the hospice election is beyond the five-day requirement, the provider must fax

the election statement and a written request to the hospice coordinator at 1-800-913-2229. The

election statement must include the following information:

• KMAP provider name and number

• Facility or hospital name and address if billing for room and board charges

• Effective date of the election period

• Signature of the member or his/her legal representative

• Member Medicaid ID number

• Member date of birth

The written request must include information regarding why the election was not entered using

the KMAP website. This information is reviewed by the Prior Authorization (PA) department,

using criteria established by the state program manager. An override of the five-day requirement

must meet strict guidelines set forth by the Kansas Department of Health and Environment,

Division of Health Care Finance (KDHE-DHCF).

If the override request is approved, the election is backdated to the start date of care. If the request

is not approved, it is not backdated and the new approval date will be the date the notice of

election was received at the fiscal agent. Claims will be processed using this approved date as the

start of the hospice election.

The date the notice of election statement (NOES) is submitted to and accepted by the Medicaid

contractors is an allowable day for payment.

Example:

Admission date is 10/10/2014 (Fri).

Day 1 - Sat. 10/11/2014

Day 2 - Sun. 10/12/2014

Day 3 - Mon. 10/13/2014

Day 4 - Tues. 10/14/2014

Day 5 - Wed. 10/15/2014

10/15/2014 is the NOES due date.

If the NOES receipt date is 10/16/2014, the hospice reports 10/10 through 10/15 as noncovered

days. These days shall be a provider liability and the provider shall not bill the member

for them.

If the hospice provider fails to file a timely NOES, the provider may request an exception which,

if approved, waives the consequences of failing to file a complete and timely NOES. The four

circumstances that may qualify the hospice provider for an exception to the consequences of

filing a late NOES are:

1. Fire, flood, earthquake, or other unusual event that inflicts extensive damage to the

hospice’s ability to operate

2. An event causing a data filing problem due to a KMAP systems issue beyond the control

of the hospice

3. A newly Medicare-certified hospice that is notified of the certification after the Medicare

certification date or is awaiting a KMAP identification number

4. Other circumstances determined by the State Program Manager to be beyond the

hospice’s control

When a member elects hospice services with a pending application for Medicaid coverage,

Medicaid retro-eligibility may be granted for hospice care. The hospice provider must

submit the NOES to the fiscal agent within 30 days of Medicaid eligibility. If the provider

fails to submit the NOES in a timely manner, the hospice start of care date will NOT be

back dated.

Hospice

A public agency or private organization or a subdivision of either that is primarily engaged in

providing care to terminally ill individuals and which meets the Medicare conditions of

participation for hospices.

Hospice services are available to KMAP members who:

• Have been certified terminally ill by the medical director of the hospice or the physician

member of the hospice interdisciplinary team

• Have been certified terminally ill by the member's attending physician

• Have filed an election statement with a hospice which meets Medicare conditions of

participation for hospices

Hospice care

A comprehensive set of services described in 1861 (dd) of the Social Security Act, identified and

coordinated by an interdisciplinary group (IDG) to provide for the physical, psychosocial,

spiritual, and emotional needs of a terminally ill patient and /or family members, as delineated in

a specific patient plan of care.

Palliative care

The provision of patient and family-centered care that optimizes quality of life by anticipating,

preventing, and treating suffering. Palliative care throughout the continuum of illness involves

addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient

autonomy, access to information, and choice.

Note: The hospice must ensure that each patient and the primary care giver (s) receive education

and training provided by the hospice as appropriate to their responsibilities for the care and

services identified in the plan of care.