La. Medicaid Services Manual ch. 24 (Hospice) § 24.7

When a beneficiary revokes or is discharged alive during an election period, the beneficiary loses

any remaining days in the election period. The beneficiary may at any future time elect to receive

hospice coverage for any other hospice periods for which they are eligible.

This requirement will affect both Medicaid-only and dual eligibles. The Centers for Medicare and

Medicaid Services (CMS) requires the election and revocation/discharge to be simultaneous for

both payer sources. If a beneficiary is eligible for Medicare as well as Medicaid (dual eligible) and

revokes hospice care, the revocation forms must be submitted to the appropriate agency in

compliance with the agency’s requirements simultaneously.

The date of discharge (except discharge due to death) is not reimbursed by Medicaid.

Revocations

A beneficiary or their legal representative may revoke the election of hospice care at any time

during an election period. This is a right that belongs solely and exclusively to the beneficiary or

legal representative.

At no time is the hospice provider to demand a revocation. In addition, the hospice beneficiary or

legal representative must not be asked to sign a blank form to be completed by the hospice provider

prior to submission to the Prior Authorization Unit (PAU) through an electronic prior authorization

(e-PA). In the event it is discovered during the verification process that a hospice provider

encouraged revocation for the purpose of potentially avoiding hospice related charges, and the

beneficiary or legal representative is in agreement, the revocation will not be honored.

Required Statement of Revocation

When a beneficiary revokes or is discharged alive during an election period, the beneficiary or

legal representative must sign and date a statement acknowledging that they are aware of the

revocation and state reason the revocation is chosen. This written statement must be completed by

the beneficiary or legal representative and include the beneficiary’s contact information.

The statement must be submitted to the hospice PAU for verification and follow up.

A signed statement must include t he date the revocation is to be effective. A beneficiary or their

legal representative cannot designate an effective date earlier than the date that the revocation is

made. The date of signature and proper written statement must also be included. This revocation

shall be received by the hospice PAU within five calendar days of revocation.

At no time will the effective date be earlier than the date the request is signed. Revocations that

are back dated will be forwarded to the Medicaid Program Integrity Section for investigation for

possible fraudulent activity. A verbal revocation of benefits is NOT acceptable.

The requirements for revocation and time limits also apply to beneficiaries who have both

Medicare and Medicaid eligibility (dual eligible).

Discharges

A hospice provider must discharge a beneficiary from hospice care upon receipt of a revocation

statement or upon discovery the beneficiary is not terminally ill.

Reasons for Discharge

Beneficiaries must be discharged only in the following circumstances:

1. There is a change in terminal status;

2. The beneficiary relocates from the hospice's geographically defined service area;

3. The safety of the beneficiary or of the hospice staff is compromised. The hospice

provider must make every effort to resolve these problems satisfactorily before

discharge, and efforts must be documented in detail in the beneficiary’s clinical

record;

4. Medicaid-only beneficiaries who enter a non-contracted nursing home or hospital

and all options have been exhausted (a contract is not attainable, the beneficiary

chooses not to transfer to a facility with which the hospice provider has a contract,

or to a hospice provider with which the skilled nursing facility (SNF) has a

contract). The hospice provider must notify the payer source to document that all

options have been pursued and that the hospice provider is not discharging the

beneficiary without due cause; and

5. The hospice provider determines that the beneficiary’s (or other persons in the

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

that delivery of care to the beneficiary, or the ability of the hospice staff to operate

effectively, is seriously impaired.

The hospice provider must do the following before it seeks to discharge a beneficiary for cause:

1. Advise the beneficiary that a discharge for cause is being considered;

2. Make a serious effort to resolve the problem(s) presented by the beneficiary’s

behavior or situation;

3. Ascertain that the beneficiary’s proposed discharge is not due to the beneficiary’s

use of necessary hospice services;

4. Document the problem(s) and efforts made to resolve the problem(s) and enter this

documentation into the beneficiary’s clinical record; and

5. Obtain a written physician’s discharge order from the hospice medical director prior

to discharging a beneficiary for any reason.

NOTE: If a beneficiary has an attending physician involved in their care, the physician should be

consulted before discharge with their review and decision included in the discharge note. This

order shall be submitted to the hospice PAU with the required Medicaid discharge forms within

five calendar days.

Documentation of Discharge

The hospice provider must clearly document why it was necessary to discharge the beneficiary.

Within five calendar days after discharge, the provider must submit the Notice of Termination with

type bill 81B or 82B via the Bureau of Health Services Financing (BHSF) Form Hospice – Notice

of Election (NOE) through e-PA so the files may be updated in a timely manner.

Discharge/Revocation Due to Hospital Admit

It is against Medicaid hospice policy to encourage beneficiaries to revoke hospice services when

they have an inpatient admission, emergency room (ER) visit, ambulance transport or other

outpatient services and re-elect hospice after services are delivered. These cases will be verified

and closely monitored by the hospice PAU for referral to Program Integrity.

Service Availability upon Revocation or Discharge

A beneficiary is no longer covered for hospice care under Medicaid upon discharge or revocation.

All previously waived benefits will resume.

NOTE: This does not apply to waiver services received prior to hospice election.

Notice of Transfer

A Notice of Transfer is sent when the beneficiary is in the middle of an election period and wants

to change hospice providers. A beneficiary may change hospice providers once each election

period. The date of discharge from the current hospice provider must be only one day before the

date of admission to the newly designated hospice provider.

Within five calendar days after discharge, the transferring hospice provider must submit the signed

a type bill 81 C via BHSF Form-Hospice through e-PA so the files may be updated in a timely

manner. The new hospice provider receiving the beneficiary must also submit a completed notice

of transfer (81C) to the hospice PAU within five days of receipt of transfer. Refer to Appendix A

of this chapter.

Late Notifications

Failure to submit Notices of Revocation, Discharge or Transfer in a timely manner can result the

inability for other pro viders to bill for services. Late submissions will be monitored b y the

department and PAU, and may be subject to monetary penalties.

Revocations received through e-PA that are more than five days old can be submitted with any

proof of prior attempts to submit timely. For example, a fax confirmation sheet reflecting the

appropriate discharge/revocation form with explanation (81B) is acceptable as proof as long as

there is a successful fax transmission with a date on the confirmation sheet. A blank or failed fax

confirmation sheet is not acceptable.