W. Va. BMS Provider Manual § 509.11.1

For each individual who applies for Hospice coverage in a nursing facility, election of services and

physician certification documentation is required (refer to BMS manual Chapter 514, Nursing Facility

Services).The Hospice provider must submit the following information to the UMC for review:

•

An agreement between the specific nursing facility and the Hospice provider specifying the

appropriate services each will provide to qualified members;

•

Documentation to support the individual’s medical necessity for each covered service;

•

Financial eligibility documentation for the specific individual regarding the Medicare and the

Medicaid programs.

As with Hospice services provided in other settings, those provided in nursing facilities apply only to the

terminal illness and related conditions. For health needs not related to the terminal diagnosis, additional

West Virginia Medicaid policies and procedures are to be followed.

The authorization information must be submitted with the first claim for payment.