Revision 13-4; Effective December 1, 2013

 

Persons eligible for full Medicaid benefits may elect to participate in the Texas Medicaid Hospice Program if they have a medical prognosis of six months or less to live. In order to enroll in the Texas Medicaid Hospice Program, the person or authorized representative signs and dates Form 3071, Individual Election/Cancellation/Update. This election remains in effect until another Form 3071 is completed canceling hospice election. Recipients electing hospice waive their rights to other Medicaid services related to treatment of the terminal illness(es). They do not waive their rights to Medicaid services that are not related to treatment of the terminal illness(es). Hospice services may be received at home, in a hospital or in a Medicaid-contracted long-term care facility.

 

A-5100 Hospice in the Community

Revision 11-4; Effective December 1, 2011

 

Persons residing in a community-based living arrangement, such as their home or a hospital, may elect to participate in the Texas Medicaid Hospice Program if they are eligible for full Medicaid benefits. This means that they qualify as an SSI recipient (ME-Temp Manual SSI or ME-SSI) or an MEPD recipient in the community (certified under ME-Pickle, ME-Disabled Adult Child or ME-Early Aged Widow(er)).

Persons whose only eligibility is MC-SLMB, MC-QMB and MC-QDWI may not participate in the Texas Medicaid Hospice Program because they receive only limited Medicaid coverage. However, they may be entitled to receive Medicare hospice services.

For a list of programs, see the TIERS Policy and Procedures Guide, Section A-6, Type Program Lists in the Texas Integrated Eligibility Redesign System (TIERS) in the Texas Works Handbook.

 

A-5200 Hospice in a Long-Term Care Facility

Revision 13-4; Effective December 1, 2013

 

A Medicaid recipient may elect to receive hospice services in a Medicaid-certified nursing facility (NF) or intermediate care facility for individuals with an intellectual disability or related conditions (ICF/IID). In order to receive Medicaid hospice services, the person must meet all eligibility criteria for MEPD in a long-term care facility, including confinement in one or more Medicaid-certified long-term care facilities for 30 consecutive days. Form 3071, Individual Election/Cancellation/Update, substitutes for the medical necessity determination when hospice is elected.

The hospice provider informs the eligibility specialist of the possibility of hospice election by a recipient. When the recipient (or authorized representative) signs and dates Form 3071, the hospice provider contacts the eligibility specialist, providing the effective date that the recipient is starting/electing hospice services. The hospice provider follows up this contact by sending Form 3071 to the contractor for Medicaid claims, with a copy to the eligibility specialist.

For Medicaid hospice residents in long-term care facilities, the hospice provider is responsible for collecting the applied income, and the nursing facility manages the patient trust fund. The hospice provider is responsible for completing Form 3071 in the event of any change in the hospice provider, cancellation of the hospice election, and death. There is normally no need for the eligibility specialist to take any action in response to any of these changes. The automated system receives this information through interfacing with the Service Authorization System Online (SASO) and communication with DADS. If the eligibility worker becomes aware of the death of the recipient, manual denial of the case should be taken.