WAC 388-551-1200   Client eligibility for hospice care.  (1) A client who elects to receive hospice care must be eligible for one of the following medical assistance programs, subject to the restrictions and limitations in this chapter and other WAC:

     (a) Categorically needy program (CNP);

     (b) Limited casualty program - medically needy program (LCP-MNP);

     (c) Children's health (V);

     (d) State children's health insurance program (SCHIP);

     (e) CNP -- Alien emergency medical;

     (f) LCP-MNP -- Alien emergency medical; or

     (g) General assistance-expedited disability (GAX).

     (2) A hospice agency is responsible to verify a client's eligibility with the client or the client's home and community services (HCS) office or community services office (CSO).

     (3) A client enrolled in one of the department's managed care plans must receive all hospice services, including facility room and board, directly through that plan. The client's managed care plan is responsible for arranging and providing all hospice services for a client enrolled in a managed care plan.

     (4) A client who is also eligible for medicare part A is not eligible for hospice care through the department's hospice program. The department does pay hospice nursing facility room and board for these clients if the client 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 388-551-1530.

     (5) A client who meets the requirements in this section is eligible to receive hospice care through the department's hospice program when all of the following is met:

     (a) The client's physician certifies the client has a life expectancy of six months or less.

     (b) The client elects to receive hospice care and agrees to the conditions of the "election statement" as described in WAC 388-551-1310.

     (c) The hospice agency serving the client:

     (i) Notifies the department's hospice program within five working days of the admission of all clients, including:

     (A) Medicaid-only clients;

     (B) Medicaid-medicare dual eligible clients;

     (C) Medicaid clients with third party insurance; and

     (D) Medicaid-medicare dual eligible clients with third party insurance.

     (ii) Meets the hospice agency requirements in WAC 388-551-1300 and 388-551-1305.

     (d) The hospice agency provides additional information for a diagnosis when the department requests and determines, on a case-by-case basis, the information that is needed for further review.



[Statutory Authority: RCW 74.08.090, 74.09.520. 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. 99-09-007, § 388-551-1200, filed 4/9/99, effective 5/10/99.]