N.D. Medicaid Billing and Policy Manual, Hospice Services, Applicability

Eligible Providers

To receive payment from ND Medicaid, the eligible servicing and billing provider

National Provider Identifiers (NPI) must be enrolled with ND Medicaid on the date of

service. Servicing providers acting as a locum tenens provider must be enrolled with ND

Medicaid and be listed on the claim form. Please refer to provider enrollment for

additional details on enrollment eligibility and supporting documentation requirements.

Eligible Members

Providers are responsible for verifying a member’s eligibility before providing services.

Eligibility can be verified using the ND Medicaid MMIS Portal or through the through the

Automated Voice Response System by dialing 1.877.328.7098.

A member must be certified as terminally ill for coverage of hospice care. Hospice care

may continue until a member is no longer certified as terminally ill, until the member or

representative revokes the election of hospice, or until the member’s date of death.

A member may live in a home in the community or in a long-term care facility while

receiving hospice services. A long-term care facility is a nursing facility, swing bed

facility, or intermediate care facility for the intellectually disabled.

A dually eligible member must elect or revoke hospice care simultaneously under both

the Medicare and the Medicaid programs.

Refer to the Member Eligibility Manual for additional information regarding eligibility

including information regarding limited coverage categories.

Hospice Election

A hospice election must be submitted for a member who is eligible for hospice care and

who wishes to elect hospice benefit period. A client who meets the eligibility

requirements must elect hospice care by filing a written election statement with a

particular hospice provider.

Election statements must include the following elements:

• The effective date of the election, which may be the first day of hospice care or a

later date but may be no earlier than the date of the election statement;

• Identification of the particular hospice and of the attending physician that will

provide care to the individual. The individual or representative must acknowledge

that the identified attending physician was his or her choice;

• The client’s (or legal representative’s) acknowledgment that he or she has been

given a full understanding of the palliative rather than curative nature of hospice

care as it relates to the client’s terminal illness;

• For adult clients, acknowledgment that the client waives certain services as

stated in 42 CFR 418.24(g);

• Acknowledgment that the client (or legal representative) may revoke the election

of the hospice benefit at any time in the future. Adults must also acknowledge

that revocation of hospice benefits will result in restoration of Medicaid benefits

that were waived at the time of hospice election;

• Signature of the client or legal representative; and

• The client’s date of birth.

Upon certification, a client may elect to receive hospice care for an initial 90-day period.

After certification, the client may elect the hospice benefit for:

• two subsequent 90-day periods; or

• an unlimited number of subsequent 60-day periods.

An election to receive hospice care remains effective through the initial election period

and through the subsequent election periods without a break in care as long as the

patient:

• remains in the care of a hospice;

• does not revoke the election; and

• is not discharged from the hospice.