Tex. HHSC Medicaid Hospice Provider Manual § 4570

Revision 08-1; Effective November 12, 2008

When a dually eligible individual on hospice requires an SNF bed for treatment unrelated to his terminal illness, Medicaid hospice room and board payments end. An SNF bed is only appropriate for those aspects unrelated to the terminal illness. The first 20 days are paid by Medicare at 100%. Days 21-100 (or upon discharge, whichever occurs first) are paid by coinsurance through HHSC TDHconnect/TMHP. Part of this coinsurance is considered the room and board payment. The nursing facility (NF) submits Form 3619, Medicare/SNF Patient Transaction Notice. A Minimum Data Set (MDS) assessment is not required during this period. The hospice provider must submit Form 3071, Individual Election/Cancellation/Update, to TMHP as an update for admission into the SNF bed. The date in box No. 3 is the date the individual is admitted into the SNF bed.

Coinsurance for drugs will apply to dually eligible individual on hospice who are in an SNF bed. For more information, see Item 4550, Coinsurance for Drugs.

When the individual is readmitted into the regular NF coverage, an MDS, will be completed if necessary. The hospice provider must submit Form 3071 to TMHP as an update for discharge from the SNF bed. The date in box No. 3 is the date the individual is discharged from the SNF bed.

Please note that coinsurance for respite services does not apply to dually eligible individuals on hospice residing in an NF.