Mississippi Administrative Code › Title 23 - Division of Medicaid › Part 205 - Hospice Services › Chapter 1 - Program Overview › Rule 23-205-1.3 - Certification and Recertification of Terminal Illness

Current through June 25, 2024
A.
				Only a Medicaid enrolled medical doctor or doctor of osteopathy can certify or
				recertify a terminal illness.
B. A
				beneficiary who reaches a point of stability and no longer meets the definition
				of terminally ill must not be recertified and must return to Medicaid benefits,
				if eligible.
C. The physician(s)
				signing the written certification/recertification statement can be held liable
				for causing false claims to be submitted.
D. Certifications/recertifications of
				terminal illness are based on the clinical judgment of the certifying
				physician(s) regarding the normal course of the beneficiary's terminal illness
				and must conform to the following requirements:
1. The certification/recertification must
				specify that the beneficiary's prognosis is for a life expectancy of six (6)
				months or less if the terminal illness runs its normal course.
2. Clinical information and other
				documentation that support the medical prognosis of six (6) months or less must
				accompany the certification including, but not limited to,
a) Terminal diagnosis and related diagnoses,
b) Specific clinical findings,
				prognostic indicators, functional ability scales, symptom management scales,
				and other pertinent medical documentation,
c) Coordinating national or local coverage
				determinations, if any,
d)
				Laboratory reports,
e) Radiology
				reports, and/or
f) Pathology
				reports.
3. The
				certifying physician must complete a brief narrative explanation of the
				clinical findings that supports a life expectancy of six (6) months or less on
				the certification/recertification form, or as an attachment to the
				certification/recertification form.
a) If the
				narrative exists as an attachment to the certification/recertification form, in
				addition to the physician's signature on the certification/recertification
				form, the physician must also sign immediately following the narrative in the
				addendum.
b) The narrative must
				include a statement directly above the physician signature attesting that by
				signing, the narrative is based on his/her review of the beneficiary's medical
				record or, if applicable, his/her examination of the beneficiary.
c) The narrative must reflect the
				beneficiary's individual clinical circumstance and cannot contain check boxes
				or standard language used for all beneficiaries.
d) The narrative associated with the third
				election period recertification and every subsequent recertification must
				include an explanation of why the clinical findings of the face-to-face
				encounter support a life expectancy of six (6) months or less.
4. The physician or nurse
				practitioner who performs the face-to-face encounter with the beneficiary must
				attest in writing that he or she had a face-to-face encounter with the
				beneficiary, including the date of the visit. The attestation of the nurse
				practitioner or a non-certifying hospice physician must state the clinical
				findings of that visit were provided to the certifying physician for use in
				determining continued eligibility for hospice care.
5. All certifications/recertifications of
				terminal illness must be signed, dated, and must include the election period
				dates to which the certification or recertification applies.