471 Neb. Admin. Code, ch. 36, § 006 - ELECTION OF HOSPICE SERVICES

A client or the client's legal representative must file a voluntary, written expression to choose hospice care, called an election statement designating the Medicaid Hospice Benefit as the care preference for terminal illness. The election statement must include:

1. The date that hospice services are to begin;

2. The name of the hospice provider; and

3. The client's signature or the signature of the client's legal representative when client is unable to sign. The reason the client can not sign must be documented.

A client who has Medicare coverage must use Medicare coverage as primary payer until Medicare benefits are exhausted. Medicaid pays the Medicare co-insurance and deductible when the client is covered by both Medicare and Medicaid. See 471 NAC 3-004.

006.01 Hospice's Responsibilities at Election

When a client elects to receive hospice services, the hospice program must:

1. Explain the benefits the client will receive;

2. Explain the benefits the client is waiving;

3. Give the client or legal representative a copy of the signed statement; and

4. Retain the signed statement in its files.

006.02 Benefit Periods

Medicaid provides two 90-day benefit periods during the client's lifetime. If additional benefit periods are needed, Medicaid provides three 60-day benefit periods. Hospice services beyond these benefit periods must be approved as an exception under the prior authorization provisions in 471 NAC 36-007. The benefit periods may be used consecutively or at intervals.

36-006.02A Certification: The client must be certified as terminally ill with a six- month life expectancy by the hospice medical director and the attending physician at the beginning of the first benefit period and by the hospice medical director for all subsequent benefit periods.

006.03 Waiver of Medicaid Benefits for Adult Clients

An adult client shall be deemed to have waived all rights to Medicaid payment for treatment associated with the terminal illness for the duration of the election of hospice care. Medicaid services provided for conditions/illnesses that are unrelated to the terminal illness may be covered by Medicaid separate from the hospice benefit. These services shall be based on individual assessed need and medical necessity as specified in the appropriate chapters of Title 471. If the client/representative revokes election of the Medicaid Hospice Benefit, Medicaid coverage of the benefits deemed to have been waived is restored.

006.04 Revocation of Election of Hospice Benefit

A client/representative may revoke election of the hospice benefit at any time. The days that are remaining in the current benefit period are lost. The client/representative shall initiate the process of revocation and follow through with the hospice provider.

The client may initiate re-election of the Medicaid Hospice Benefit if eligibility criteria are met.

006.05 Change of Hospice

The client/representative may choose to change from one hospice provider to another hospice provider. A change of hospice may occur only once in each benefit period.

Notes

471 Neb. Admin. Code, ch. 36, § 006