Tex. HHSC Medicaid Hospice Provider Manual § 3610

Revision 06-2; Effective December 12, 2006

Hospice providers must advise applicants to apply for Medicaid at either an HHSC office or the nearest SSA office, whichever is appropriate, in order to become a Medicaid recipient. HHSC or SSA determines and approves the financial eligibility of applicants. Providers must verify Medicaid eligibility. Contact the local HHSC Community Care Aged and Disabled (CCAD) case manager and HHSC ME staff to advise them that a potential or current Medicaid recipient is interested in or has elected the Medicaid Hospice Program. Keep the HHSC ME staff and HHSC CCAD case manager informed as changes occur in the applicant's hospice status, financial condition, marital status, living arrangements, etc. Providers must maintain contact with HHSC ME staff in order to be informed regarding an individual's Medicaid eligibility status, especially in those instances where an individual is dually eligible for Medicare and Medicaid.

Applicants must elect hospice care by signing and dating Form 3071, Individual Election/Cancellation/Update, with an approved Medicaid hospice provider.

The elections remain in effect unless the individual and the hospice representative sign and date Form 3071 to cancel hospice coverage in both programs.

A physician provides a written statement on Form 3074, Physician Certification of Terminal Illness, which certifies that an applicant has a prognosis of six months or less to live. This prognosis must be current in order for Medicaid coverage to start and to continue.

In order to receive payment, providers must correct and resubmit all rejected election forms and physician certifications to the Texas Medicaid & Healthcare Partnership (TMHP). TMHP must have Form 3071 and Form 3074 before payments can be made for Medicaid hospice services and room and board. For more information regarding form submission, see Section 4200, Claims Management System (CMS).