To be eligible for Medicaid hospice payment, the hospice must
document that services provided meet the following requirements.
(1) The hospice providing the services must have a
Medicaid hospice contract with HHSC on the date it provides services.
(2) The services must be reasonable and necessary for
the palliation or management of the terminal illness, as well as conditions
related to the terminal illness.
(3) The hospice must deliver the services on or after
the date the individual elects hospice care in accordance with §266.205
of this subchapter (relating to Election of Hospice Care) but before
the date the individual revokes the election of hospice care in accordance
with §266.207 of this subchapter (relating to Revoking the Election
of Hospice Care).
(4) The hospice election statement must identify the
hospice requesting payment as the individual's hospice provider.
(5) A physician must certify that the individual receiving
hospice services is terminally ill in accordance with §266.203
of this subchapter (relating to Certification of Terminal Illness).
(6) The individual receiving services must be eligible
for Medicaid.
(7) The hospice must establish an individualized plan
of care prior to initiating services.
(8) The services the hospice provides must be consistent
with the plan of care.
(9) If the individual receiving services lives in a
nursing facility or ICF/IID, the hospice must have a contract with
that nursing facility or ICF/IID.
(10) If the individual receiving services is dually
eligible for Medicare and Medicaid, the hospice service must not be
covered by the Medicare hospice benefit.
(11) The hospice must submit both the Individual Election/Cancellation/Update
Form and the Physician Certification of Terminal Illness Form to the
TMHP Long Term Care Online Portal.
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