Mich. Medicaid Provider Manual, Hospice § 7.2

Hospice services are included in the Medicaid Health Plan (MHP) covered services package for Medicaid

enrollees. If the terminally ill enrollee requests and meets the criteria for hospice services, the MHP must

cover the requested hospice services. If the terminally ill enrollee does not request hospice services, the

MHP may provide its own array of services for the terminally ill. If the beneficiary is enrolled in a MHP

(eligibility response indicates the Benefit Plan ID of CSHCS-MC, MA-HMP-MC, MA-MC or MME-MC), the

hospice must contact the MHP immediately to receive prior authorization (PA) from the MHP before

furnishing services. The MHP may require its enrollees to receive hospice services through a contracted

hospice with which they have made arrangements. MHPs are responsible for the hospice care

arrangement and payment if the eligibility response indicates a Benefit Plan ID of CSHCS-MC, MA-HMP-MC, MA-MC or MME-MC for the beneficiary.

If a fee-for-service (FFS) Medicaid beneficiary is automatically enrolled in a MHP while receiving hospice

care, the beneficiary or their representative should contact the MDHHS Hospice Enrollment Coordinator if

they wish to continue receiving services from their current hospice provider. (Refer to the Directory

Appendix for contact information.) The Hospice Enrollment Coordinator initiates the process of

disenrollment from the MHP. It is not the intent of MDHHS to disrupt a hospice beneficiary’s care

through automatic enrollment in a MHP. If the beneficiary is subsequently discharged from hospice care,

the beneficiary may be offered the opportunity to join a MHP.

* The fourth Medicare benefit period is the subsequent extension period during the beneficiary’s lifetime that occurs after the first

two 90-day periods, and subsequent 60-day period, have been utilized.

If the MHP enrollee requires hospice services in a NF or hospice-owned NF, the MHP pays a negotiated

rate for room and board in addition to the payment for the hospice services. The hospice must contact

the MHP prior to admitting the beneficiary for hospice services to request authorization by the MHP.