Wash. HCA Hospice Services Billing Guide, How does a hospice agency become an approved PPC provider?

Note: This section does not apply to providers who already are

HCA-approved PPC providers.

To apply to become an HCA-approved PPC provider, a provider must:

• Be an approved hospice agency with Medicaid (see About the Hospice

Program).

• Submit a letter to HCA’s Hospice/PPC program (see Resources Available)

requesting to become an HCA-approved provider of PPC and include a copy

of the provider’s policies and position descriptions with minimum

qualifications specific to pediatric palliative care.

Provider requirements

WAC 182-550-1840

An eligible provider of PPC case management/coordination services must do all

of the following:

• Meet the conditions in How does a hospice agency become approved to

provide Medicaid services?

• Confirm that a client meets the eligibility criteria prior to providing PPC

services.

• Obtain a written referral to HCA’s PPC program manager from the client’s

physician.

• Determine and document in the client’s medical record the medical necessity

for the initial and ongoing care coordination of PPC services.

• Document in the client’s medical record:

o A palliative plan of care (POC) (a written document based on assessment of

a client’s individual needs that identifies services to meet those needs).

o The medical necessity for those services to be provided in the client’s

residence.

o Discharge planning.

• Provide medically necessary skilled interventions and psychosocial counseling

services by qualified interdisciplinary hospice team members.

• Assign and make available a PPC case manager (nurse, therapist, or social

worker) to implement care coordination with community-based providers to

ensure clarity, effectiveness, and safety of the client’s POC.

• Notify HCA’s PPC program manager within five business days from the date of

occurrence of the client’s:

o Date of enrollment in PPC.

o Discharge from the hospice agency or PPC when the client:

▪ No longer meets PPC criteria.

▪ Is able to receive all care in the community.

▪ Does not require any services for 60 days.

▪ Discharges from PPC to enroll in HCA’s Hospice program.

• Transfer to another hospice agency for pediatric palliative care services.

• Death.

Note: See Pediatric Palliative Care (PPC) Referral and 5-Day

Notification form, HCA 13-752. See Where can I download HCA

forms?

• Maintain the client’s file which includes the POC, visit notes, and all the

following:

o The client’s start of care date and dates of service

o Discipline and services provided (in-home or place of service)

o Case-management activity and documentation of hours of work

o Specific documentation of the client’s response to the palliative care and

the client’s and/or client’s family’s response to the effectiveness of the

palliative care (e.g., the client might have required acute care or hospital

emergency room visits without the pediatric palliative care services)

• Provide when requested by HCA’s PPC program manager, a copy of the

client’s POC, visit notes, and any other documents listing the information

identified above.

If HCA determines that the documentation in the POC or attachments to the POC

does not meet the criteria for a client’s PPC eligibility or does not justify the billed

amount, any payment to the provider is subject to recoupment by HCA.

Note: Therapy services may be provided in outpatient settings

and billed with the client’s Services Card. Outpatient therapy may

not be appropriate for some children and may be best served in

the home. The documentation on the Pediatric Palliative Care

(PPC) Plan of Care (POC) would note the medical necessity.