405 IAC 5-34-2 - Provider enrollment
Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-40
Affected: IC 12-15; IC 16-25-3
Sec. 2.
(a) In order
to enroll as a hospice provider in Medicaid a provider must submit a provider
enrollment agreement as specified in
405 IAC 5-4. A separate provider
agreement for hospice services must be completed even if the provider currently
participates in Medicaid as a provider of another service.
(b) A hospice provider must be certified as a
hospice provider in the Medicare program. A copy of the provider's Medicare
Certification Letter from the Centers for Medicare and Medicaid Services (CMS),
formerly the Health Care Financing Administration, must be submitted with the
Medicaid provider enrollment agreement. The hospice provider who operates at
more than one (1) location must provide a copy of the Medicare Certification
Letter from CMS that demonstrates that the regional office has approved each
additional office location to be Medicare-certified as a either a satellite
office of the home office location or as a separate hospice with its unique
Medicare provider number.
(c) The
provider must comply with all state and federal requirements for Medicaid and
Medicare providers in addition to the requirements in this section. The hospice
and all hospice employees must be licensed in accordance with applicable
federal, state, and local laws and regulations as required under federal
regulations at 42 CFR
418.72 and Indiana state hospice licensure at
IC 16-25-3.
(d) The hospice provider must designate an
interdisciplinary group composed of individuals who are employees of the
hospice and who provide or supervise care and services offered by the hospice
provider. At a minimum, this group must include all of the following persons:
(1) A medical director, who must be a doctor
of medicine or osteopathy.
(2) A
registered nurse.
(3) A social
worker.
(4) A pastoral or other
counselor.
(e) The
interdisciplinary group is responsible for the following:
(1) Participation in the establishment of the
plan of care.
(2) Provision or
supervision of hospice care and services.
(3) Review and updating of the plan of
care.
(4) Establishment of policies
governing the day-to-day provision of care and services.
(f) A hospice provider may not discontinue or
diminish care provided to the Indiana member because of the member's source of
payment.
(g) The provider must
demonstrate respect for a member's rights by ensuring that the election of
hospice services is based on the informed, voluntary consent of the member or
the member's representative.
(h) A
hospice provider may discharge a member from hospice services only if one (1)
or more of the following occurs:
(1) The
member dies.
(2) The member is
determined to have a prognosis greater than six (6) months.
(3) The member moves out of the hospice's
service area.
(4) The safety of the
member, other patients, or hospice staff is compromised.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
Authority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-40
Affected: IC 12-15; IC 16-25-3
Sec. 2.
(a) In order to enroll as a hospice provider in Medicaid a provider must submit a provider enrollment agreement as specified in 405 IAC 5-4. A separate provider agreement for hospice services must be completed even if the provider currently participates in Medicaid as a provider of another service.
(b) A hospice provider must be certified as a hospice provider in the Medicare program. A copy of the provider's Medicare Certification Letter from the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration, must be submitted with the Medicaid provider enrollment agreement. The hospice provider who operates at more than one (1) location must provide a copy of the Medicare Certification Letter from CMS that demonstrates that the regional office has approved each additional office location to be Medicare-certified as a either a satellite office of the home office location or as a separate hospice with its unique Medicare provider number.
(c) The provider must comply with all state and federal requirements for Medicaid and Medicare providers in addition to the requirements in this section. The hospice and all hospice employees must be licensed in accordance with applicable federal, state, and local laws and regulations as required under federal regulations at 42 CFR 418.72 and Indiana state hospice licensure at IC 16-253.
(d) The hospice provider must designate an interdisciplinary group composed of individuals who are employees of the hospice and who provide or supervise care and services offered by the hospice provider. At a minimum, this group must include all of the following persons:
(1) A medical director, who must be a doctor of medicine or osteopathy.
(2) A registered nurse.
(3) A social worker.
(4) A pastoral or other counselor.
(e) The interdisciplinary group is responsible for the following:
(1) Participation in the establishment of the plan of care.
(2) Provision or supervision of hospice care and services.
(3) Review and updating of the plan of care.
(4) Establishment of policies governing the day-to-day provision of care and services.
(f) A hospice provider may not discontinue or diminish care provided to the Indiana member because of the member's source of payment.
(g) The provider must demonstrate respect for a member's rights by ensuring that the election of hospice services is based on the informed, voluntary consent of the member or the member's representative.
(h) A hospice provider may discharge a member from hospice services only if one (1) or more of the following occurs:
(1) The member dies.
(2) The member is determined to have a prognosis greater than six (6) months.
(3) The member moves out of the hospice's service area.
(4) The safety of the member, other patients, or hospice staff is compromised.