Tex. HHSC Medicaid Hospice Provider Manual § 3640

Revision 06-2; Effective December 12, 2006

A resident in a Medicaid-certified NF who is dually eligible may elect to participate in either the Medicaid or Medicare Hospice Program. When a dually eligible NF resident elects hospice under either Medicaid or Medicare, the hospice benefit must be elected or revoked under both programs and each program notified as to the resident's decision. The hospice and NF must have a written agreement under which the hospice takes full responsibility for the professional management of the resident's hospice care and the facility agrees to provide room and board to the individual.

Providers must submit Form 3071, Individual Election/Cancellation/Update, and Form 3074, Physician Certification of Terminal Illness, for dually eligible individuals regardless of their place of residence. For more information regarding form submission, see Section 4200, Claims Management Systems (CMS).

In order to receive payment from HHSC for room and board for dually eligible residents, a hospice provider must have a valid Medicaid provider agreement. Information on room and board is outlined in Item 4540, Room and Board. Information on Medicaid eligibility is outlined in Section 3200, Three-Month Prior Eligibility.

Information on hospice program requirements for dually eligible individuals for both the Medicaid and Medicare programs may be found in several Centers for Medicare and Medicaid Services publications:

State Operations Manual, Section 2082, Election of Hospice Benefit by Resident of SNF, NF, ICF/MR or Non-Certified Facility;

Hospice Manual, Section 204.2, Skilled Nursing Facility and Nursing Facilities Residents and Dually Eligible Beneficiaries; and State Medicaid Manual, Section 4305, Hospice Services.