Mont. Medicaid Hospice Policy Manual, Policy 406

REASONS

FOR DISCHARGE

A hospice may discharge a member if the following occurs:

1. The member moves out of the hospice's service area or

transfers to another hospice;

2. The hospice determines that the member is no longer

terminally ill; or

3. The hospice determines that the member's (or other

persons in the member's home) behavior is disruptive,

abusive, or uncooperative to the extent that delivery of

care to the member or the ability of the hospice to operate

effectively is seriously impaired.

The hospice agency must have a discharge procedure in place. If

the hospice agency and member are unable to resolve issues

presented by a member’s behavior or situation, the hospice must

do the following before it seeks to discharge a member for cause:

1. Advise the member that a discharge for cause is being

considered;

2. Ascertain that the member's proposed discharge is not due

to the member's use of necessary hospice services; and

3. Document the problem(s) and efforts made to resolve the

problem(s) and enter this documentation into its medical

records.

DISCHARGE

ORDER

Prior to discharging a member for any reason listed in sections (1)

through (3) above (“Reason for Discharge”), the hospice must

obtain a written physician's discharge order from the hospice

medical director. If a member has an attending physician involved

in his or her care, this physician should be consulted before

discharge, and his or her review and decision must be included in

the discharge note.

EFFECT OF

DISCHARGE

A member, upon discharge from the hospice during a particular

election period for reasons other than immediate transfer to another

hospice:

1. I s no longer covered under Medicaid for hospice care;

2. R

esumes Medicaid coverage of the benefits waived under

37

.40.815, (Refer to Hospice Policy 404); or

3. M

ay at any time elect to receive hospice care if the

m

ember is again eligible to receive the benefit.

DISCHARGE

PLANNING

The hospice must have in place a discharge planning process that

takes into account the prospect that a member's condition might

stabilize or otherwise change such that the member cannot

continue to be certified as terminally ill.

The discharge planning process must include planning for any

necessary family counseling, member education, or other services

before the member is discharged because he or she is no longer

terminally ill.

FILING A NOTICE OF

TERMINATION

OF ELECTION

When the hospice election is ended due to discharge, the hospice

must file a notice of termination/revocation of election with the

Department within five calendar days after the effective date of the

discharge, unless the hospice has already filed a final claim for that

member.