5160-56-03 Hospice services: discharge requirements.

The purpose of this rule is to detail circumstances in which the individual would no longer receive the medicaid hospice benefit.

(A) Discharge from hospice care:

(1) The hospice shall discharge the individual from hospice care when the individual:

(a) Expires;

(b) No longer meets the enrollment criteria;

(c) No longer is terminally ill;

(d) Moves out of the service area;

(e) Enters a non-contracted facility;

(f) Revokes the hospice benefit according to paragraph (B) of this rule;

(g) Transfers to another hospice; or

(h) Compromises the safety of the individual or the safety of the hospice staff.

(2) The hospice shall complete a written statement of discharge, retain the original for its records and provide the individual or representative with a copy. The written statement of discharge must clearly state the reason for discharge except when the patient expires. A written statement of discharge should not be provided to the individual's representative when the individual expires, unless requested from the representative.

(B) Revocation of the election of hospice care:

(1) The individual receiving the medicaid hospice benefit may choose to revoke the election of hospice care once during each benefit period. Upon revocation of the medicaid hospice benefit, regular medicaid coverage resumes . The individual may choose to re-elect the hospice benefit at any time.

(2) The hospice must obtain a written statement of revocation signed and dated by the individual or representative, retain the original for its records, and provide the individual or the representative with a copy. The written statement of revocation must clearly state the reason for the revocation.

(C) The individual who voluntarily revoked the hospice benefit, or who has been discharged from hospice care, may elect the benefit at a later date if the individual qualifies as terminally ill and otherwise meets the requirements of the medicaid hospice benefit as follows:

(1) The individual who revoked the hospice benefit or who was discharged from the hospice benefit during the initial ninety-day period would enroll in the hospice program in the second ninety-day benefit period; or

(2) The individual who revoked the hospice benefit or who was discharged from the hospice benefit during the second ninety-day benefit period, or any subsequent sixty-day benefit period, would begin the new enrollment in a new sixty-day benefit period.

(D) Transfer to another hospice:

(1) The individual or the representative may change the designation of the particular hospice from which hospice care is received once during each benefit period. The change of the designated hospice is not considered a revocation of the election from the period in which it is made.

(2) To change the designated hospice, the individual or the representative must file, with the hospice from which the individual has received care and the newly designated hospice, a signed statement the includes the following information:

(a) The name of the hospice from which the individual has received care;

(b) The name of the hospice from which the individual plans to receive care; and

(c) The date the change is to be effective.

(E) The individual who has elected the hospice benefit and decided to revoke, terminate, or transfer his or her hospice benefit must do so on the same effective date for both the third-party covered or medicare hospice benefit and the medicaid hospice benefit.

(F) Any denial or termination of hospice care which is the result of an Ohio department of medicaid (ODM) decision shall be subject to the notice and hearing rights contained in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code.

Effective: 4/1/2015
Five Year Review (FYR) Dates: 12/19/2014 and 04/01/2020
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.03, 5164.70
Prior Effective Dates: 5/16/90, 12/1/91, 4/1/94, 9/26/02, 1/1/04, 3/2/08