This rule sets forth the requirements
for discharging an individual from the designated hospice's care and/or the
Discharge refers to the end the hospice benefit and/or
the designated hospice's care:
Discharge from the designated hospice's care shall
occur when the individual:
No longer meets
the hospice enrollment or eligibility criteria;
No longer is
terminally ill, e.g., physician discharges or does not recertify the
Moves out of the service area;
Enters a facility
where the designated hospice has no access and/or cannot enter to provide
Revokes the hospice benefit in accordance with
paragraph (B) of this rule;
another hospice in accordance with paragraph (D) of this rule;
Is discharged for cause, such as compromising the
safety of self or the safety of the hospice staff.
provider must notify the Ohio department of medicaid (ODM) through the medicaid
information technology system (MITS) or its designee of the individual's
discharge from the designated hospice's care so that the designated hospice's
services and billings coincide with the date of the individual's discharge
and/or so that hospice services may continue with the new hospice when
applicable, e.g., following a transfer.
Except for the
reason cited in paragraph (A)(1)(a) of this rule, the designated hospice shall
complete a written summary statement which clearly states the reason(s) for the
individual's discharge from the designated hospice's care. The original
statement of discharge shall be retained by the hospice for its records, with a
copy provided to the individual. As a reason for discharge, a hospice provider
may not automatically or routinely discharge an individual at its "discretion"
or request or demand that the individual revoke his or her
With the exception of paragraph (A)(1)(g) of this rule,
when an individual is discharged from a designated hospice's care, the current
election period (as defined in rule
of the Administrative Code) shall end and the individual shall be discharged
from the hospice benefit entirely, making him or her no longer eligible to
receive medicaid hospice services.
provider shall respect the right of the individual to revoke the election of
the hospice benefit at any time during any given election period.
Upon notice of
the individual's intent to revoke, the designated hospice shall:
Obtain a written
statement, signed and dated by the individual, which states that the election
of hospice care has been revoked by the individual for the remainder of the
applicable benefit period. The designated hospice shall not accept a verbal
revocation of the hospice benefit;
individual from hospice care, such that hospice coverage for the remaining days
in that election period is forfeited and medicaid coverage of the benefits
waived when hospice care was elected may resume; and
individual with a copy of the written revocation statement and maintain the
original for its record.
shall be permitted to re-elect the medicaid hospice benefit at any time after
revocation pursuant to paragraph (C) of this rule, provided the individual
meets all hospice eligibility requirements.
If the individual
remains eligible for hospice, a designated hospice may enroll an individual at
any time after the re-election.
The individual discharged from hospice care during the
initial ninety-day period, who re-elects the hospice benefit, shall be enrolled
in the second ninety-day benefit period; or
who revoked the hospice benefit or who was discharged from hospice care during
the second ninety-day benefit period, or any subsequent sixty-day benefit
period, who re-elects the hospice benefit, shall be enrolled in a subsequent
sixty-day benefit period.
requirements apply when an individual is discharged from the designated
hospice's care due to individual's transfer to another hospice:
may change the designation of the hospice from which care is received once
during each benefit period. The change of the designated hospice is not
considered a revocation of the election from the period in which it is
To change the designated hospice, the individual must
file, with the hospice from which the individual has received care and the
newly designated hospice, a signed statement which includes the following
The name of the hospice from which the individual has
The name of the hospice from which the individual plans
to receive care; and
The date the change is to be effective.
an individual transfers from one hospice to another, his or her medicaid
hospice benefit shall continue without interruption of care.
individual who has elected the hospice benefit and decided to revoke,
terminate, or transfer his or her hospice benefit must do so on the same
effective date for both the third-party covered or medicare hospice benefit and
the medicaid hospice benefit. When the dual eligible individual revokes his or
her medicare hospice benefit, the provider shall ensure the medicaid hospice
benefit is revoked by the individual at the same time.
Any denial or
termination of hospice care which is the result of an Ohio department of
medicaid (ODM) decision shall be subject to the notice and hearing rights
contained in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code.
Ohio Admin. Code
Five Year Review (FYR) Dates:
Effective Dates: 5/16/90, 12/1/91, 4/1/94, 9/26/02, 1/1/04, 3/2/08,