Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-079 - State Plan Amendment #2006-008 and Hospice Update #55

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 4.19-B METHODS AND STANDARDS FOR ESTABLISHING
				PAYMENT RATES -OTHER TYPES OF CARE
18.
			 Hospice Care
Arkansas Medicaid reimburses hospice providers in accordance
				with the Medicaid fee schedule and hospice wage index requirements pubhshed
				annually by CMS. For the Routine Home Care and Continuous Home Care rates, the
				hospice wage index to be applied to the wage component subject to index is
				based on the location of the individual's home. For the Inpatient Respite Care
				and General Inpatient Care rates, the hospice wage index to be applied to the
				wage component subject to index is based on the location of the hospice. Pubhc
				and private providers are reimbursed the same rates.
ATTACHMENT 3.1-A
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
18. Hospice Care
! The hospice patient must be terminally ill which is defined
				as having a medical prognosis with a life expectancy of six months or less. The
				terminal illness must be certified by the patient's attending physician and
				hospice services prescribed.
! Patients must voluntarily elect to receive hospice services
				and choose the hospice provider. Hospice election is by Aelection periods-.
				Election periods in the Arkansas Medicaid Hospice Program correspond to the
				election periods established for Medicare. The initial hospice election period
				is of 90 days duration and is followed by a second 90-day election period. The
				patient is then eligible for an unlimited number of 60-day election
				periods.
! Election of the hospice benefit results in a waiver of the
beneficiary's
rights to payment for only those services which are
				related to the treatment of the terminal illness or related conditions and
				common to both Title XVIII and Title XIX. The
beneficiary
does not
				waive rights to payment for services related to the terminal illness that are
				unique to Title XIX.
! Hospice services must be provided primarily in a patient's
				residence.
A patient may elect to receive hospice services in a nursing
				facility
or an intermediate care facility for the mentally retarded
				(ICF/MR)
if the hospice and the facility have a written agreement under
				which the hospice takes full responsibility for the professional management of
				the patient's hospice care, and the facility agrees to provide room and board
				to the patient.
! Hospice services must be provided consistent with a written
				plan of care.
! Dually eligible (Medicare and Medicaid)
beneficiaries
must elect hospice care in the Medicare and
Medicaid hospice programs simultaneously to be eligible for
				Medicaid hospice services.
ATTACHMENT 3.1-B
AMOUNT, DURATION AND SCOPE OF SERVICES PROVIDED
18. Hospice Care
! The hospice patient must be terminally ill which is defined
				as having a medical prognosis with a life expectancy of six months or less. The
				terminal illness must be certified by the patient's attending physician and
				hospice services prescribed.
! Patients must voluntarily elect to receive hospice services
				and choose the hospice provider.
Hospice election is by Aelection periods-. Election periods in
				the Arkansas Medicaid Hospice Program correspond to the election periods
				established for Medicare. The initial hospice election period is of 90 days
				duration and is followed by a second 90-day election period. The patient is
				then eligible for an unlimited number of 60-day election periods.
! Election of the hospice benefit results in a waiver of the
beneficiary's
rights to payment for only those services which are
				related to the treatment of the terminal illness or related conditions and
				common to both Title XVIII and Title XIX. The
beneficiary
does not
				waive rights to payment for services related to the terminal illness that are
				unique to Title XIX.
! Hospice services must be provided primarily in a patient's
				residence.
A patient may elect to receive hospice services in a nursing
				facility
or an intermediate care facility for the mentally retarded
				(ICF/MR)
if the hospice and the facility have a written agreement under
				which the hospice takes full responsibility for the professional management of
				the patient's hospice care, and the facility agrees to provide room and board
				to the patient.
! Hospice services must be provided consistent with a written
				plan of care.
! Dually eligible (Medicare and Medicaid)
beneficiaries
must elect hospice care in the Medicare and Medicaid hospice program
				simultaneously to be eligible for Medicaid hospice services.
Provider Manual Update Transmittal #55
200.000 HOSPICE GENERAL
			 INFORMATION
201.000
Arkansas
			 Medicaid Participation Requirements for IHospice
Providers
201.100
Enrollment Criteria
Providers of hospice services must meet
the
following criteria to be eligible for participation in the Arkansas
				Medicaid Program:
A. The hospice
			 provider must be certified as a Title XVIII (Medicare) hospice provider.
1. The provider must submit a copy of the
			 Medicare certification to Provider Enrollment when submitting the Hospice
			 Program application and contract.
2. Subsequent Medicare certifications must be
			 forwarded to Provider Enrollment within 30 days of issuance.
3. Failure to ensure that current Medicare
			 certification is on file with Provider Enrollment will result in termination
			 from the Arkansas Medicaid Program.