R.I. Medicaid Provider Manual, Hospice Services 300-20, Medical Conditions For Coverage

Hospice care is covered by the Medical Assistance Program for beneficiaries who are terminally ill. A beneficiary will be considered to be terminally ill if there is a medical prognosis that life expectancy is six months or less. There must be a certification by the beneficiary’s attending physician and the medical director (or staff physician) of the hospice program providing the care, that the beneficiary is terminally ill.

The beneficiary must elect to receive hospice care from a Medicare Certified hospice program. A spouse or legal Guardian may sign the election form, however, the relationship to the beneficiary must be documented on the Hospice Election form next to the signature. The beneficiary must also elect to give up their right to have the Medical Assistance Program pay for:

1. Hospice care provided by hospice programs other than the one the beneficiary has chosen (unless the chosen hospice program arranges for services to be provided by another program), and;

2. Any other Medical Assistance Program services furnished during the elected period that are determined to be related to the treatment of the beneficiary's condition for which diagnosis of terminal illness has been made or which are equivalent to or duplicative of hospice care.

However, item 2 above does not apply to physicians' services furnished by the patient's attending physician if the physician is not an employee of the hospice program or if the services provided by or under arrangements are made by the chosen hospice program.

A beneficiary may revoke hospice care election before the period has expired, thereby reinstating eligibility for other Medical Assistance Program benefits. A copy of this revocation form must be sent to EOHHS, Medicaid Program, Office of Long Term Services and Supports within 10 business days of revoking Hospice Care. A beneficiary may, at any time after such a revocation, make a new hospice care election.

If a beneficiary elects to receive hospice care, he/she must choose to receive his/her care from a hospice program and give up his/her right to receive curative treatment for the specified terminal illness. However, this election is revocable.