W. Va. BMS Provider Manual § 509.5.3

The Hospice provider must develop a Plan of Care designed to meet the member’s individual needs.

Members must be informed that by electing Hospice services, they must waive Medicaid coverage of the

following services if they are related to the member’s terminal condition:

•

Hospice care provided by a Hospice other than the Hospice designated by the member, unless

provided under arrangements made by the designated Hospice; and

•

Any Medicaid services that are related to treatment of the terminal condition for which Hospice

care was elected or of a related condition; or that are equivalent to Hospice care except for

services:

o

Provided (either directly or under arrangement) by the designated Hospice;

o

Provided as room and board by a nursing facility or Intermediate Care Facilities for

Individuals with Intellectual Disabilities (ICF/IID) if the individual is a resident; and

o

Provided by the member’s attending physician if that physician is not an employee of the

designated Hospice or receiving compensation from the Hospice for those services.

When an election period ends or the Hospice discharges a member according to reasons for discharge

under 42 CFR §418.26 (a thru d), the member’s waiver of other Medicaid benefits expires. Also, regular

Medicaid coverage is reinstated if the member revokes Hospice care for the subsequent election period

(in accordance with 42 CFR §418.24 and §418.28).

Hospice care does not include, but is not limited to the following:

•

Services furnished before or after a Hospice election period;

•

Services of the member’s attending physician, if the attending physician is not an employee of or

working under an arrangement with the Hospice; or

•

Medicaid services received for the treatment of an illness or injury not related to the member’s

terminal condition (please see 42 CFR §418.402).

Once a member elects to receive Hospice services, Medicaid will not reimburse for other Medicaid

services that treat the terminal condition. However, Medicaid may reimburse for services that are required

to treat conditions that are unrelated to the terminal illness.

An exception to this rule is that Hospice services may be provided to children under age 21 concurrently

with curative treatment in accordance with the Affordable Care Act 2302 Concurrent Care for Children.