NH · guidance
N.H. Medicaid Hospice Provider Manual, Vol. II, § 2, Change in Designated Hospice Provider
Change in Designated Hospice Provider.
A member or his or her agent or legal guardian may change the designated hospice provider once in
each of the election periods specified above.
The member or his or her agent or legal guardian shall complete the hospice care provider’s change of
designated provider form, and provide it to the current hospice provider and the newly designated
hospice provider.
The member’s current hospice provider shall provide written notification to the Department within 5
state business days of a member changing his or her designated hospice provider by submitting a
completed Form 282A, “Medicaid Hospice Care Notification Form” (found on the NH MMIS Health
Enterprise portal at www.nhmmis.nh.gov).
The member’s current hospice provider shall forward the following to the newly designated hospice
provider:
1. A copy of the election statement obtained by the current hospice provider; and
2. A copy of the certification of terminal illness obtained by the current hospice provider.
The newly designated hospice provider shall comply with all requirements of He-W 544, except that
the forms forwarded by the member’s current hospice provider, as described above, may be used in
place of completing new documents.
Provenance
- Source
- nhmmis.nh.gov
- Retrieved
- 2026-10-02
- Edition
- nh-hospice-pm-2014-04-01
- Content hash
6a2c47c4c93c0438378749166ed48a29da16fd56dcbf9e20b73149826b982d4d
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