Utah Admin. Code R414-14A-3 - Member Eligibility Requirements
(1)
Hospice benefits are available to categorically and medically needy
Medicaid-eligible individuals.
(2)
A member, or representative if the member is incapacitated, must file an
election statement with a hospice agency when choosing to use the hospice
benefit.
(3) A member who has been
assessed and provided with a written certification of terminal illness from a
physician may obtain hospice services in accordance with
42 CFR
418.22.
(4) A member dually enrolled in Medicare and
Medicaid must elect the hospice benefit for both Medicare and Medicaid in
accordance with
42 CFR
418.21 and
418.24.
The member must receive hospice coverage under Medicare primarily. Election for
the Medicaid hospice benefit provides the member coverage for Medicare
coinsurance and room and board expenses while admitted to a Medicare-certified
nursing facility, intermediate care facility for people with an intellectual
disability ICF/ID, or freestanding hospice facility.
(5) A primary diagnosis of debility or
failure to thrive in adults does not meet eligibility criteria for the coverage
of hospice services.
Notes
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