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PDFWAC 182-551-1200

Client eligibility for hospice care.

(1) A person who elects to receive hospice care must be eligible for one of the Washington apple health programs listed in the table in WAC 182-501-0060 or be eligible for the alien emergency medical (AEM) program (see WAC 182-507-0110), subject to the restrictions and limitations in this chapter and other WAC.
(2) A hospice agency is responsible to verify a person's eligibility with the person or the person's department of social and health services (DSHS) home and community services (HCS) office or community services office (CSO).
(3) A person enrolled in one of the medicaid agency's managed care organizations (MCO) must receive all hospice services, including facility room and board, directly through that MCO. The MCO is responsible for arranging and providing all hospice services for an MCO client.
(4) A person who is also eligible for medicare hospice under part A is not eligible for hospice care through the medicaid agency's hospice program. The medicaid agency does pay hospice nursing facility room and board for these persons if the person is admitted to a nursing facility or hospice care center (HCC) and is not receiving general inpatient care or inpatient respite care. See also WAC 182-551-1530.
(5) A person who meets the requirements in this section is eligible to receive hospice care through the medicaid agency's hospice program when all of the following is met:
(a) The person's physician certifies the person has a life expectancy of six months or less.
(b) The person elects to receive hospice care and agrees to the conditions of the "election statement" as described in WAC 182-551-1310.
(c) The hospice agency serving the person:
(i) Notifies the medicaid agency's hospice program within five working days of the admission of all persons, including:
(A) Medicaid-only persons;
(B) Medicaid-medicare dual eligible persons;
(C) Medicaid persons with third-party insurance; and
(D) Medicaid-medicare dual eligible persons with third-party insurance.
(ii) Meets the hospice agency requirements in WAC 182-551-1300 and 182-551-1305.
(d) The hospice agency provides additional information for a diagnosis when the medicaid agency requests and determines, on a case-by-case basis, the information that is needed for further review.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148). WSR 14-07-042, § 182-551-1200, filed 3/12/14, effective 4/12/14. Statutory Authority: RCW 41.05.021. WSR 13-04-094, § 182-551-1200, filed 2/6/13, effective 3/9/13. Statutory Authority: RCW 41.05.021, Section 2302 of the Patient Protection and Affordable Care Act of 2010 (P.L. 111-148), and Section 1814 (a)(7) of the Social Security Act. WSR 12-09-079, § 182-551-1200, filed 4/17/12, effective 5/18/12. WSR 11-14-075, recodified as § 182-551-1200, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 05-18-033, § 388-551-1200, filed 8/30/05, effective 10/1/05. Statutory Authority: RCW 74.09.520, 74.08.090, 42 C.F.R. 418.22 and 418.24. WSR 99-09-007, § 388-551-1200, filed 4/9/99, effective 5/10/99.]
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