Tex. HHSC Medicaid Hospice Provider Manual § 6100

Revision 06-2; Effective December 12, 2006

A hospice provider must enter into an agreement with a long term care facility that is interested in participating in the hospice program. The agreement must contain at least the following:

description of the hospice and contractor roles in the admission process, individual/family assessment, and the interdisciplinary group care conferences.

services to be provided.

a stipulation that services related to the terminal illness may be provided only with the express authorization of the hospice.

the manner in which the contracted services are coordinated, supervised and evaluated by the hospice.

requirements for documenting services that are furnished in accordance with the agreement.

qualifications of the personnel providing the services.

the Medicaid hospice provider's responsibilities, which are the professional management of an individual's hospice care, the provision of all hospice services on a timely basis as indicated on the Medicaid hospice plan of care, and collection and management of the copay.

the hospice provider maintains records on the hospice plan of care, including the services provided by hospice staff, in the current NF clinical or ICF/MR-RC resident record. The hospice provider maintains a summary of an individual's long term care facility care plan and records in the hospice provider's plan of care case record.

the long term care facility agrees to provide certain services to the individual on Medicaid hospice on a timely basis that complement and support the hospice services under the Medicaid hospice plan of care.

the Medicaid hospice provider agrees to pay the NF or ICF/MR-RC provider the HHSC Medicaid room and board rate that is paid to the hospice. If the hospice provider agrees to pay the facility more than this rate, the rate cannot go above the 100% rate and the agreement must specify the additional service the facility will provide. Anything above the 100% rate is considered Medicaid fraud and is reported to the federal government.