W. Va. BMS Provider Manual § 509.7

In accordance with 42 CFR §418.26, §418.28, and §418.30, Hospice services may be terminated for any

of the following reasons:

•

The member chooses to revoke Hospice care;

•

The Hospice chooses to terminate its provision of services;

•

The member no longer meets enrollment criteria;

•

The member moves out of the Hospice’s service area;

•

The member transfers to another Hospice provider;

•

The member’s environment becomes unsafe for Hospice staff; or

•

The member dies.

When a member revokes Hospice services or is discharged by the Hospice provider, the Hospice

provider must send a copy of the HEF-01, with original member signature and the date of the termination

of services written in the box marked Revoked, to the UMC. This must be received by the UMC within

eight calendar days of revocation to allow the member to resume Medicaid benefits waived upon election

of Hospice care. When a member is being discharged and will be in need of medication and/or medical

supplies upon discharge, then the Hospice provider must expedite the discharge election form to the

UMC.

The Hospice provider must send a copy of the HEF-01 to the UMC following the death of the member

with the date of death noted in the appropriate box.