MO HealthNet Hospice Provider Manual § 2.2

The participant must be eligible for MO HealthNet coverage for each date of service for reimbursement to be made to a provider. The participant must also be certified as being terminally ill and must have elected to receive hospice services.

To be eligible to elect hospice care under MO HealthNet, individuals must be certified by a physician as being terminally ill. Individuals are considered terminally ill if they have a medical prognosis that their life expectancy is six (6) months or less. Hospice services must be reasonable and necessary for the palliation or management of the terminal illness and related conditions. Individuals must elect hospice care and agree to seek only palliative care for the duration of the hospice enrollment. Care may be provided in the home, a NF, intermediate care home, or in a hospital. Participants must be made aware that by the election of hospice services they waive MO HealthNet coverage of active treatment of the terminal condition.

Concurrent Care for Children

MO HealthNet hospice services for children (ages 0-20) may be concurrent with the care related to curative treatment of the condition for which a diagnosis of a terminal illness has been made. The hospice provider continues to be responsible for all services related to the palliation and support services for the terminally ill.

Claims for curative treatment services for children enrolled in hospice should be submitted for reimbursement by the provider of the service in the same manner as claims for individuals not enrolled in hospice. Claims for curative services will be reviewed on an individual basis.

Managed Care Program

Hospice services are included as a plan benefit in Missouri’s MO HealthNet Managed Care program.

Managed Care health plans are responsible for paying for hospice services if the patient goes on hospice prior to admitting to a NF or intermediate care home and is enrolled in a Managed Care health plan.

Fee-For-Service (FFS) MO HealthNet is responsible for hospice services when a participant is enrolled in Managed Care and is in a NF or intermediate care home or admitted to a NF or intermediate care home prior to going on hospice. The participant will be disenrolled from the Managed Care health plan after a level of care is determined, or after 60 calendar days; whichever comes first.

Refer to the General Sections Manual for more information on the Managed Care Program.

Pending Eligibility

It is the hospice provider’s responsibility to verify patients’ MO HealthNet coverage. Eligibility dates can be verified in eMOMED or by calling Provider Communications at (573) 751-2896 or toll-free at (833) 222-7916.

When the hospice patient’s MO HealthNet eligibility is pending or is suspect (the participant does not have a MO HealthNet or Managed Care ID card or a new approval letter), it is suggested that the hospice provider periodically check to verify approval of eligibility prior to submission of election documentation.

Do not submit election documentation to MHD for a patient who has not been approved for MO HealthNet. The patient, patient’s family, or authorized representative may apply for MO HealthNet. Refer to Section 2.6 in this manual for more information on the election procedures.