Vt. Medicaid Hospice Provider Manual § 9

Admission

A Medicare member who resides in a Skilled Nursing Facility or Nursing Facility may elect the

hospice benefit if:

• The residential care is paid for by the member; or

• The member is eligible for Medicaid and the facility is being reimbursed for the member’s

care by Medicaid, and

• The hospice and the facility have a written agreement under which the hospice takes full

responsibility for the professional management of the member’s hospice care and the

facility agrees to provide room and board to the member.

Prior to admission to Hospice services the following 804B form must be completed and submitted

to the Department of Vermont Health Access (DVHA).

Hospice Revocation

A member or representative may revoke the election of hospice care at any time in writing;

however, a hospice cannot “revoke” a member’s election.

Change in Provider

The receiving hospice agency must file a new Notice of Election; however, the benefit period

dates are unaffected.

VT Choices for Care & Brain Injury 804 Change Report Form Process

Discharge from Hospice

Discharge from a hospice can occur as a result of one of the following:

• The member decides to revoke the hospice benefit;

• The member transfers to another hospice;

• The member dies;

• The member moves out of the geographic area that the hospice defines in its policies as its

service area.

See Medicare Guidelines.