Mich. Medicaid Provider Manual, Hospice § 6.7.E

If a beneficiary receiving private duty nursing (PDN) becomes eligible for hospice, the

hospice is required to notify the MDHHS Program Review Division before a claim is

submitted for the services. (Refer to the Directory Appendix for contact information.)

The hospice must provide the following information on agency letterhead to the Program

Review Division:

• beneficiary name and Medicaid ID number;

• a request for a case review and approval of hospice services;

• a statement confirming that the beneficiary has been certified terminally ill with six

months or less to live, signed by the hospice medical director and the beneficiary's

attending physician; and

• name, e-mail address, and telephone number of the contact person.

Program Review Division staff may request additional medical record documentation for

their review. If services are approved, the hospice must work with the PDN agency to

develop a coordinated plan of care. Both the hospice and PDN staff must ensure that

duplication of services does not occur. While hospice maintains the lead in coordinating

the services, the PDN agency must continue to obtain prior authorization from MDHHS

for the PDN services.

This does not apply to beneficiaries receiving PDN services under the Habilitation

Supports Waiver (HSW) and over 21, or the MI Choice Waiver. For beneficiaries under

the HSW, providers should contact the beneficiary's case manager to inform them of

hospice eligibility. If the beneficiary is under the MI Choice Waiver, providers should

contact the MI Choice Waiver Supports Coordinator.