WI · guidance

Wis. ForwardHealth Online Handbook, Hospice, Topic #1178

A Comprehensive Overview

activein force · 2026-10-01 – presentcompiled-edition

The documentation outlined in this service area is required for all members receiving the hospice benefit. With the exception of the

Notification of Hospice Benefit Election (F-01008 (05/2023)) form, providers may use the forms in the Hospice service area of

the Online Handbook or substitute their own forms, as long as the provider's form contains all of the same information as the

Medicaid form.

Note: Not all forms discussed in this service area should be sent to ForwardHealth; the following forms should be kept in the

member's record:

• Physician Certification/Recertification of Terminal Illness (F-01011 (08/2019))

• Election of Hospice Benefit for Members 20 and Under (F-01009A (12/2010)) OR Election of Hospice Benefit for

Members 21 and Older (F-01009B (12/2010))

• Hospice Benefit Revocation (Non-Recertification)/Voluntary Discharge (F-01010 (08/2019)), if applicable

Provenance

Source: www.forwardhealth.wi.gov
Retrieved: 2026-10-02
Edition: forwardhealth-hospice-2026-10-01
Content hash: 5c4b6351a0eaead8220d77480b7ec7dff3de8df6747388e7f708f3371f64ec61

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