Utah Admin. Code R414-14A-4 - Program Access Requirements
(1) The
hospice agency must operate and furnish services in compliance with applicable
federal, state, and local laws and regulations related to the health and safety
of patients.
(2) The hospice agency
must be licensed with the state, Medicare-certified in accordance with 42 CFR
418, and an enrolled Medicaid provider before initiating hospice services. At
the time of a change of ownership, the previous owner's provider agreement
terminates as of the effective date of the change of ownership.
(3) Medicaid accepts waivers granted to
hospice agencies by the Centers for Medicare and Medicaid Services (CMS) as
part of the Medicare certification process.
(4) If a member who resides in a nursing
facility, ICF/ID, or a freestanding hospice inpatient facility elects to
receive hospice benefits, the hospice agency and the facility must have a
written agreement in which a comprehensive service plan specifies the total
care of the member.
(a) The agreement must
outline that the hospice agency is responsible for the professional management
of the member's hospice care.
(b)
The facility agrees to provide room and board and services unrelated to the
care of the terminal condition of the member.
(5) The agreement must include the following:
(a) identification of the services to be
provided by the hospice agency and the facility as well as the method of care
coordination to ensure services are consistent with the hospice approach to
care and are organized to achieve the outcomes defined by the hospice plan of
care;
(b) a stipulation that
services may be provided only with the express authorization of the hospice
agency;
(c) how the contracted
services are coordinated, supervised, and evaluated by the hospice
agency;
(d) the delineation of the
roles of the hospice agency and the facility in the admission process that
includes an assessment process, an interdisciplinary team care conference, and
a service planning process;
(e)
requirements for documenting that services are furnished following the
agreement;
(f) the qualifications
of the personnel providing the services; and
(g) the billing and reimbursement process by
which the facility will bill the hospice agency for room and board to receive
reimbursement from the hospice agency.
Notes
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