N.C. Medicaid Clinical Coverage Policy No. 3D § 7.6

A beneficiary may change hospice provider between election periods and once during

each election period. A provider change is not a revocation of hospice. When a change

occurs during an election period, the beneficiary completes the period with the new

provider.

To change provider during an election period, the beneficiary gives a signed statement to

the current provider and the new provider. The statement indicates the beneficiary’s intent

to change provider, the name of the current provider is provided, the new provider name is

stated, and identifies the effective date of the change.

The transfer is coordinated with the attending physician and any other care providers to

ensure continuity of services. The current or first provider shall cease billing for services

on the day prior to the effective date on the notice. The new provider assumes

responsibility for the beneficiary’s care on the effective date of the change and bills for

that date of service. The existing plan of care can be used, or the new provider may

develop a new one.

The first provider shall report the transfer to DHHS fiscal contractor. Payment to the new

provider depends on a report of the termination of services by the first provider. The new

provider shall contact DHHS fiscal contractor to report the admission of the beneficiary to

hospice services under the new provider. Both providers shall report the transfer to DHHS

fiscal contractor no later than the sixth (6th) day after the date of transfer [day of report

plus six previous days].