Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-56 - Medicaid Hospice Program › Section 5160-56-04 - Hospice services: provider requirements

Current through all regulations passed and filed through July 1, 2024
This rule sets forth the responsibilities, including the
				conditions of participation for a hospice engaged in the provision of medicaid
				hospice services. To be eligible to provide and to request reimbursement for
				hospice services, a designated hospice must:
(A) Be eligible to participate in the Ohio
			 medicaid program upon execution of a provider agreement in accordance with rule
			 5160-1-17.2 of the Administrative Code.
(B) Meet the medicare guidelines in
			 accordance with 42 C.F.R. part 418 (October 1, 2017).
(C) Be licensed under Ohio law in accordance
			 with Chapter 3712. of the Revised Code by the Ohio department of
			 health.
(D) Comply with all
			 requirements for medicaid providers in Chapter 5160-1 of the Administrative
			 Code.
(E) Ensure that all hospice
			 employees, volunteers, and contracted staff who provide direct services to
			 hospice individuals are trained, licensed, certified, and/or registered in
			 accordance with applicable federal and state law. ODM
			 will allow hospices to utilize pseudo-patients, such as a person trained to
			 participate in a role-play situation or a computer-based mannequin device
			 instead of real patients, in competency testing of hospice aides and allow
			 individuals who are competency tested only in the tasks for which they will be
			 assigned to function as hospice aides.
(F) Not discontinue or diminish the hospice
			 care provided to the individual because of the inability of the individual to
			 pay or receipt of medicaid reimbursement for such care pursuant to the medicare
			 requirements outlined in Section 1861 (dd)(2)(D) of the Social Security Act,
			 42
			 U.S.C. 1395x(dd)(2)(D) (as
			 in effect January 1, 2017).
(G)
			 Arrange for another individual or entity to furnish services to the individual
			 in accordance with
			 42
			 C.F.R. 418.56 (October 1, 2017) when the
			 designated hospice cannot provide services to the individual. This arrangement
			 must include a signed agreement which shall remain on file at the hospice
			 agency.
(H) Assume responsibility
			 for the professional management of the individual's hospice care. Professional
			 management involves the assessment, planning, monitoring, directing and
			 evaluation of the individual's hospice care across all settings. The designated
			 hospice must provide for and ensure the ongoing sharing of information between
			 all disciplines providing care and services in all settings, whether the care
			 and services are provided directly or under arrangement.
(I) Facilitate concurrent care and services
			 with other medicaid providers for which the individual under age twenty-one is
			 eligible. As a responsibility for the professional management of the
			 individual's hospice care, the designated hospice shall:
(1) Ensure hospice services are maintained
			 and coordinated with concurrent care services;
(2) Document the delineation in which
			 services and the assessment process are coordinated between medicaid hospice
			 and non-hospice providers to avoid the duplication of equivalent or similar
			 scope of services; and
(3) Maintain
			 up-to-date contact information for providers of concurrent care and
			 services.