Wash. HCA Hospice Services Billing Guide, Access to hospice care

Hospice care is included in the benefit package for all clients who receive active

coverage under one of the following programs:

• Alternative Benefits Plan (ABP)

• Categorically needy (CN)

• Medically needy (MN)

Clients under the Alien Emergency Medical program (ERSO) may be eligible for

hospice care with prior authorization (PA).

A client who is not eligible for Apple Health coverage may qualify for coverage

under a special hospice program once the Department of Social and Health

Services (DSHS) is aware the client has elected hospice. DSHS must have a copy

of the election notice on file with the Medicaid application to determine eligibility

under this program.

A client who needs Apple Health coverage to pay for nursing facility room and

board expenses (not covered by Medicare) must submit an Apple Health

application to DSHS in order to get coverage for this benefit.

The hospice agency is responsible for verifying a client’s eligibility with the client,

the client’s HCS office or CSO, or through ProviderOne as described in How do I

verify a client’s eligibility?

The hospice agency is responsible to assist the client with an application for

Apple Health and coordinate benefits with nursing facilities and DSHS LTSS

programs to ensure there is no duplication of payment.