26 Tex. Admin. Code § 266.209 - Requirements for Payments
To be eligible for Medicaid hospice payment, the hospice must document that services provided meet the following requirements.
(1) The hospice providing the services must
have a Medicaid hospice contract with HHSC on the date it provides
services.
(2) The services must be
reasonable and necessary for the palliation or management of the terminal
illness, as well as conditions related to the terminal illness.
(3) The hospice must deliver the services on
or after the date the individual elects hospice care in accordance with §
266.205 of this subchapter
(relating to Election of Hospice Care) but before the date the individual
revokes the election of hospice care in accordance with §
266.207 of this subchapter
(relating to Revoking the Election of Hospice Care).
(4) The hospice election statement must
identify the hospice requesting payment as the individual's hospice
provider.
(5) A physician must
certify that the individual receiving hospice services is terminally ill in
accordance with §
266.203 of this subchapter
(relating to Certification of Terminal Illness).
(6) The individual receiving services must be
eligible for Medicaid.
(7) The
hospice must establish an individualized plan of care prior to initiating
services.
(8) The services the
hospice provides must be consistent with the plan of care.
(9) If the individual receiving services
lives in a nursing facility or ICF/IID, the hospice must have a contract with
that nursing facility or ICF/IID.
(10) If the individual receiving services is
dually eligible for Medicare and Medicaid, the hospice service must not be
covered by the Medicare hospice benefit.
(11) The hospice must submit both the
Individual Election/Cancellation/Update Form and the Physician Certification of
Terminal Illness Form to the TMHP Long Term Care Online Portal.
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.
No prior version found.