W. Va. BMS Provider Manual § 509.11

West Virginia Medicaid maintains a separate program of Hospice services for members who are residents

of nursing facilities.

West Virginia requires a pre-admission screening (PAS) be completed on every individual who enters a

Medicaid certified nursing facility (refer to the BMS manual Chapter 514, Nursing Facility Services). If a

member electing Hospice care is a resident of a West Virginia Medicaid certified nursing facility, the

nursing facility may contract with a Medicare/Medicaid certified Hospice agency to provide room and

board for dually eligible members and for members who are Medicaid-only who qualify medically for both

the Hospice benefit and Medicaid nursing facility benefits.

Medicare certification of a nursing facility is not a requirement of this program. The Hospice agency must

enroll with the Medicaid agency to be a provider of this benefit in nursing facilities. The room and board

component provided by the nursing facility shall include the provision of a living space, nutrition, and

ancillary services normally provided for residents.

Ancillary services may include, but are not limited to, the basic activities of daily living, social and activity

programs, laundry, and housekeeping.

The Hospice provider is responsible for specialized services covered by Medicare or Medicaid including,

but not limited to, medications associated with the terminal illness, assistance with care planning, and

emotional support for the member and the member’s family.

The Hospice must bill Medicare/Medicaid for all covered services as well as Nursing facility room and

board (in accordance with 42 CFR §418.112, see the BMS manual Chapter 514 Nursing Facility

Services).

A Hospice physician or Hospice nurse practitioner must visit each Hospice member face-to-face whose

total stay across all Hospices is anticipated to reach 180 days, no more than 30 calendar days prior to the

180-day recertification, and must continue to visit that member no more than 30 calendar days prior to

every recertification thereafter in accordance with Affordable Care Act, section 3131(b).

If the Hospice is not able to complete the face-to-face visit prior to the above specifications, the Hospice

must discharge the individual and Medicaid will no longer reimburse the Hospice for the individual’s

treatment or room and board. The nursing facility will need to resume billing Medicaid for the care of the

individual; and once the face-to-face evaluation is completed by the Hospice physician or Hospice nurse

practitioner, the Hospice provider may bill the Medicaid program for services, including the pass-through

payment to the Nursing facility for room and board.

In accordance with 42 CFR §418.22, the written narrative associated with the 180-day recertification and

every subsequent recertification must meet the same requirements that are in place for Hospice enrollees

who are not residents in a nursing facility.

The nursing facility cannot charge Medicaid a bed hold if the resident/member is under the Hospice

benefit. The bed hold must be contracted between the nursing facility and the approved Hospice provider.