Mont. Medicaid Hospice Policy Manual, Policy 505

PRE-ELECTION EVALUATION

AND COUNSELING

SERVICE

Payment for hospice pre-election evaluation and counseling

services may be made to a hospice on behalf of a Medicaid

beneficiary if the requirements of this section are met. The

beneficiary must:

1. Have been diagnosed as having a terminal illness as

defined in Hospice Policy 003;

2. Have not made a hospice election; and

3. Have not previously received hospice pre-election

evaluation and consultation services specified under

this section.

SERVICES

PROVIDED

The hospice pre-election services include an evaluation of a

member’s need for pain and symptom management and counseling

regarding hospice and other care options. In addition, the services

may include advising the member regarding advanced care

planning.

PROVISION OF

PRE-ELECTION

HOSPICE SERVICES

The physician furnishing the services must:

1. Be an employee or medical director of the hospice

billing for this service; and

2. The services cannot be furnished by hospice

personnel other than employed physicians, such as

but not limited to nurse practitioners, nurses, or social

workers, physicians under contractual arrangements

with the hospice or by the beneficiary's physician, if

that physician is not an employee of the hospice; and

3. If the beneficiary's attending physician is also the

medical director or a physician employee of the

hospice, the attending physician may not provide, nor

may the hospice bill for this service because that

physician already possesses the expertise necessary

to furnish end-of-life evaluation and management, and

counseling services.

REQUIRED

DOCUMENTATION

If the member's physician initiates the request for services of the

hospice medical director or physician, appropriate documentation is

required. Documentation is required as follows:

1. The request or referral must be in writing, and the

hospice medical director or physician employee is

expected to provide a written note on the member’s

medical record.

2. The hospice agency employing the physician

providing these services is required to maintain a

written record of the services furnished.

3. If the services are initiated by the beneficiary, the

hospice agency is required to maintain a record of the

services and documentation that communication

between the hospice medical director or physician

and the beneficiary's physician occurs, with the

beneficiary's permission, to the extent necessary to

ensure continuity of care.