Utah Medicaid Provider Manual, Hospice Care Services § 8-9.1

The hospice agency must obtain written certification by an attending QHP that a

member is terminally ill. The certification of a terminal condition must be based

on a face-to-face encounter by an attending QHP conducted no more than 15

calendar days prior to the effective date of hospice election. Hospice agencies

are not reimbursed for hospice care until the physician’s certification is

complete.

Underlying conditions may not be used as qualifying terminal diagnoses for

hospice care. Hospice agencies must use ICD-10-CM coding guidelines and code

first the condition determined by the certifying QHP to be the most contributory

to a prognosis of 6 months or less. A diagnosis of debility or failure to thrive in

adults does not meet eligibility criteria for the coverage of hospice care services.

Underlying conditions can be reported as other diagnoses contributing to the

prognosis of 6 months or less.

If written certification is not obtained within 2 calendar days following the

initiation of hospice care, a verbal certification may be made within 2 days

following the initiation of hospice care, with a written certification not later than

30 days after care is initiated.