Tex. HHSC Medicaid Hospice Provider Manual § 1400

Revision 11-1; Effective May 11, 2011

Texas Medicaid & Healthcare Partnership (TMHP) pays for Medicaid services unrelated to the terminal illness. Unrelated Medicaid services include, but are not limited to, lab and x-ray, and physician services regardless of hospice status. TMHP pays non-hospice providers directly for services to an individual receiving Medicaid hospice. Non-hospice providers must submit claims to TMHP with documentation from the hospice that indicates billed services are not related to the terminal illness or that the individual was discharged from the hospice at the time services were rendered. If an individual was discharged at the time of service, the non-hospice provider obtains a copy of Form 3071, Individual Election/Cancellation/Update, from the hospice to support the claim of discharge.

In accordance with Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), individuals under 21 years of age are not required to waive Medicaid payment for treatments related to the terminal illness. Non-hospice providers rendering treatment for the terminal illness or related conditions are not required to submit documentation to indicate whether the services provided are related or unrelated to the terminal illness when the individual is under 21 years old.

Refer to TMHP's Texas Medicaid Provider Procedures Manual for further information about Medicaid services. Providers can call the TMHP Customer Service Department at 800-925-9126 or 512-514-3000 for general inquiries about the Medicaid program.