Tex. HHSC Medicaid Hospice Provider Manual § 3630

Revision 06-2; Effective December 12, 2006

When the Medicaid hospice individual cancels the Medicaid Hospice Program election, designated staff complete Form 3071, Individual Election/Cancellation/Update. The individual or responsible party and the hospice provider representative sign and date Form 3071. The provider submits Form 3071 to the Texas Medicaid & Healthcare Partnership (TMHP). For more information regarding form submission, see Section 4200, Claims Management Systems (CMS).

When a physician signs and dates a statement that an individual on Medicaid hospice is not suitable for the Medicaid Hospice Program, HHSC places the Medicaid hospice coverage and payments on hold. The Medicaid hospice coverage remains on hold until the hospice provider validates the six-month certification and individual election with another physician's statement and individual's Medicaid hospice election. If this is not accomplished in 30 days, HHSC cancels the individual's coverage under the Medicaid Hospice Program retroactive to the original date the physician stated that the individual was not suitable for the Medicaid Hospice Program.

When an individual dies, complete Form 3071 without the signature and date by the individual. Complete all other applicable items.