Utah Medicaid Provider Manual, Hospice Care Services § 10

To request hospice services, the hospice agency must submit a Hospice

Admission Record Request through PRISM. The request must include the

elections statement, the certification of terminal illness, and clinical records

supporting the hospice election, including plan of care. Requests for members

residing in a nursing facility or ICF/ID that require an allowance for room and

board must also include documentation establishing place of residence, when

applicable.

The hospice agency shall maintain documentation to support the requirement

that the service provided was medically necessary and complied with an

established plan of care.

A hospice agency may begin service for a new Medicaid hospice member for a

grace period up to 10 business days before submitting the Hospice Admission

Record Request to Medicaid. Hospice requests may be reimbursed no more than

10 days prior to the date a complete Hospice Admission Record Request is

received.

Post-payment for hospice care services will follow the criteria outlined in the

Section I: General Information Manual, Chapter 10-3: Retroactive Authorization,

while a member is in Medicaid pending status.

In order to claim service intensity add-on (SIA) payments for direct face-to-face

services rendered by a registered nurse or social worker during the last 7 days of

a hospice election ending with a patient discharged due to death, hospice

agencies must maintain documentation to support the requirement that the SIA

services provided are medically necessary and comply with an established plan

of care. Documentation includes copies of nursing and social worker notes for

the dates of service listed and any other records that document the amount of

time requested. Each face-to-face encounter must be reported with start and

end times, which may require listing multiple service lines for each of the

possible 7 dates of service.