MHCP Provider Manual, Hospice Services, Home and Community-Based Services (HCBS) after Hospice Election

When a member is receiving concurrent HCBS and hospice services, the HCBS are usually in place before the hospice services began. In some situations, a member may seek case-managed HCBS or an increase in HCBS, after electing the hospice benefit.

Example: An adult with a disability is living with an aging mother who is the primary caregiver. The aging mother experiences a decline in health status and has to cut back on the amount of primary care she is able to provide for the member. The member applies for HCBS to access available services and supports that the primary caregiver can no longer provide. When HCBS is added or the member receives an increase in HCBS after the electing hospice benefits, county case management documentation must justify the addition or increase of the services.

Documentation requirements when a case manager is involved

When the MA-covered service is the type that includes HCBS case management, the hospice provider must notify the case manager in writing of the member’s election of hospice and the anticipated start date. The hospice provider must give written notice by fax, mail, or hand delivery to the case manager within two business days using the Hospice Transaction Form (DHS-2868) (PDF).

Refer to these documentation requirements when working with a case manager:

• The hospice staff will assume lead responsibility for collaboration with the case manager and invite the case manager to participate in the hospice interdisciplinary care team meetings for a member receiving home and community-based services.

• The hospice staff must document the collaboration and forward the documentation within eight calendar days of the effective date of hospice services.

• Collaboration may be by telephone, fax, email, or a face-to-face visit. Include documentation in the member’s hospice record.

When coordinating with the hospice provider, the county case managers must add comments on the county service agreement documenting the coordination of services. The notes must indicate why continuing care services are necessary (that is, the services are preexisting or they are new but treated as a condition not related to the terminal condition).

The case manager will keep a copy of the cooperative agreement in the member’s record. (This is not a mandated form but a tool to use for preventing duplication of services.)

Note: When the member is receiving “traditional MA” home care and no case manager is involved, the hospice must coordinate care and communicate with the home care agency involved with the member, rather than through a county case manager.

County case manager approval of services that are concurrent with the hospice benefit

An MHCP internal edit will appear on the HCBS service agreement to alert counties that the member has elected the hospice benefit. To avoid duplication of service, the county case manager will be required to add a note to the service agreement and the member file to verify the services are not duplicate. After a member elects hospice, HCBS claims will suspend for review.