26 Tex. Admin. Code § 266.305 - General Contracting Requirements
(a) A
hospice participating in the Medicaid Hospice Program must comply with this
chapter and applicable federal regulations and state rules, including 42 CFR
Part 418; 26 TAC Chapter 558 (relating to Licensing Standards for Home and
Community Support Services Agencies); and 40 TAC Chapter 49 (relating to
Contracting for Community Services).
(b) A hospice participating in the Medicaid
Hospice Program must not have restrictive policies or practices, including:
(1) requiring an individual to execute a will
with the hospice named as legatee or devisee;
(2) assigning an individual's life insurance
to the hospice;
(3) transferring an
individual's property to the hospice;
(4) requiring an individual to pay a lump sum
or make any other payment or concession to the hospice beyond the recognized
Medicaid rate;
(5) controlling or
restricting an individual or legal representative in using the individual's
personal needs allowance while in a nursing facility or an ICF/IID;
(6) restricting an individual from
transferring or withdrawing from the Medicaid Hospice Program at will, except
as provided by state law;
(7)
denying appropriate hospice care to an individual on the basis of the
individual's race, religion, color, national origin, sex, age, disability,
marital status, or source of payment; and
(8) preventing or requiring the execution of
written or unwritten directives to reject life-sustaining procedures by an
adult individual.
(c) If
a hospice provides services to a resident of a nursing facility or an ICF/IID,
the hospice must have a written contract for the provision of services with the
nursing facility or ICF/IID.
(d)
Medicaid hospice-nursing facility per diem rates. The Medicaid Hospice Program
pays the Medicaid hospice provider a hospice-nursing facility rate that is no
less than 95 percent of the Medicaid nursing facility rate for each individual
in a nursing facility to take into account the room and board furnished by the
facility. When the hospice-nursing facility rate is paid to the hospice
provider, the Medicaid vendor payment to the nursing facility is not paid. Room
and board services include the performance of personal care services, including
assistance in the activities of daily living, in socializing activities,
administration of medication, maintaining the cleanliness of a resident's room,
and supervision and assisting in the use of durable medical equipment and
prescribed therapies.
(e) Medicaid
hospice-ICF/IID per diem rates. The Medicaid Hospice Program pays the Medicaid
hospice provider a hospice-ICF/IID rate that is no less than 95 percent of the
ICF/IID rate for each individual in an ICF/IID to take into account the room
and board furnished by the facility. When the hospice-ICF/IID rate is paid to
the hospice provider, the Medicaid vendor payment to the ICF/IID is not paid.
Room and board services include the performance of personal care services,
including assistance in the activities of daily living, in socializing
activities, administration of medication, maintaining the cleanliness of a
resident's room, and supervision and assisting in the use of durable medical
equipment and prescribed therapies.
(f) Medicaid payments on Medicare coinsurance
for drugs and biologicals. For Medicare-Medicaid individuals only, the Medicaid
Hospice Program pays the Medicaid hospice provider a five percent coinsurance
on prescription drugs and biologicals, not to exceed $5.00 per
prescription.
(g) Medicaid payments
for Medicare respite coinsurance. For Medicare-Medicaid individuals only, the
Medicaid Hospice Program pays the hospice provider a five percent coinsurance
for each day of respite care for up to five consecutive days of a hospice
coinsurance period.
Notes
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