Medicaid Hospice Policy Manual

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Hospice Policy: 100 - General Information
Title/Content	Policy/Form Number	Issued/Revised
Table of Contents	001	10/01/2019
Hospice Definitions	002	10/01/2019
Hospice Manual Instructions	101	10/01/2018

Hospice Policy: 200 - Program Description
Title/Content	Policy/Form Number	Issued/Revised
Legal Authority	202	10/01/2018

Hospice Policy: 300 - General Administration
Title/Content	Policy/Form Number	Issued/Revised
Member Rights	301	10/01/2018
Fair Hearing Rights	302	10/01/2018
Third Party Liability	304	10/01/2018

Hospice Policy: 400 - Eligibility of Services
Title/Content	Policy/Form Number	Issued/Revised
Eligibility Requirements	401	10/01/2018
Election Periods	402	10/01/2018
Certification of Terminal Illness	403	10/01/2019
Election of Hospice Care	404	10/01/2018
Election of Hospice Care Sample Form	404-1	10/01/2018
RESERVED	405
Discharge from Hospice Care	406	10/01/2018
Revoking Hospice Care	407	10/01/2018
Change of Designated Hospice	408	10/01/2018
RESERVED	409
Initial and Comprehensive Assessment of the Member	410	10/01/2019
Interdisciplinary Group, Plan of Care, and Coordination of Services	411	10/01/2018
Quality Assessment and Performance Improvement	412	10/01/2018
Infection Control	413	10/01/2018
Licensed Professional Services	414	10/01/2018

Hospice Policy: 500 - Eligible Services
Title/Content	Policy/Form Number	Issued/Revised
Requirements for Coverage	500	10/01/2018
Covered Services	501	10/01/2018
Special Coverage Requirements	502	10/01/2018
Admission to Hospice Care	503	10/01/2018
Non-Covered Services	504	10/01/2018
Special Requirements for Pre-Election Evaluation and Counseling	505	10/01/2018

Hospice Policy: 600 - Payment for Hospice
Title/Content	Policy/Form Number	Issued/Revised
Payment Procedures for Hospice	600	10/01/2018
Payment Rates and Adjustments for Area Wage Differences	601	10/01/2018
Hospice Cap Payment	602	10/01/2018
Submission Requirements Under the Quality Reporting Program	603	10/01/2018
RESERVED	604	10/01/2018
Hospice Reimbursement for "Room and Board" Rate and Included Services	605	10/01/2018

Hospice Policy: 700 - Service Coordination
Title/Content	Policy/Form Number	Issued/Revised
Core Services	701	10/01/2018
Furnishing Non-Core Services	702	10/01/2018
Aide and Homemaker Services	703	10/01/2018
Volunteers	704	10/01/2018
Organization and Administration of Services	705	10/01/2018
Hospice Medical Director	706	10/01/2018
Clinical Records	707	10/01/2018
Medical Supplies	708	10/01/2018
RESERVED	709
RESERVED	710
Short-Term Inpatient Care	711	10/01/2018
Inpatient Hospice Facility Compliance Requirements	712	10/01/2018
Hospice Care Provided by an SNF/NF or ICF/IID Facility	713	10/01/2018
RESERVED	714
Curative Care for Children Receiving Medicaid Hospice Services	715	10/01/2018